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May 11, 2015 by |

Whistleblowers and Medicare Fraud in the Healthcare Industry

ATTORNEY NEWSLETTER

The Department of Justice is investigating Medicare risk scores, as whistleblower lawsuits alleging billing abuses in privately run Medicare plans have recently increased. At least half a dozen of these lawsuits have been filed under the False Claims Act since 2010, including two that recently surfaced.

Medicare Advantage uses risk scores to pay higher rates for sicker patients, and lower rates for patients in better health. However, according to these whistleblower lawsuits, some plans are claiming that patients are sicker than they actually are in order to get higher Medicare payments for inflated risk scores. For example, private Medicare Advantage health plans reported rates of diabetes with medical complications more than twice as often as for people in standard Medicare.

Medicare Advantage is popular with seniors due to its low out-of-pocket costs, and more than 17 million people (about one-third of those eligible) have signed up for privately run Medicare Advantage plans. Annual taxpayer costs for Medicare Advantage are upwards of $150 billion, so increased oversight of the program could save billions of dollars. Federal health officials were advised of widespread overcharges and billing errors as far back as 2009.

Companies such as DaVita Healthcare Partners, Inc., based in Denver, and Humana Inc., based in Louisville, have revealed that they have received Justice Department subpoenas, or have been notified regarding a Justice Department investigation, regarding Medicare billing records.

Evans Law Firm, Inc. handles whistleblower and qui tam (False Claims) lawsuits. If you have a potential whistleblower claim, please contact Evans Law Firm, Inc. at 415-441-8669 or via email at info@evanslaw.com.

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