San Francisco, CA, 07/11/2015 /SubmitPressRelease123/
Government healthcare programs are suffering financial losses because they’re paying for healthcare services that were not actually provided, according to Kathleen Scanlan healthcare whistleblower lawyer with the law firm of Keller Grover located in San Francisco. She specializes in representing whistleblowers, helping them and navigate the legal process while making sure they understand their own rights and the way the laws can protect them in their efforts to expose a fraud on the government.
Paying for services not rendered, according Ms. Scanlan, is a common fraud that Medicare and Medicaid has to deal with. Government funded healthcare programs contract to pay for services provided to patients. “A classic fraud is the provider billing the government, saying they did something when they actually didn’t,” she says.
“There are a lot of different cheats that can happen. One of them is using ghost patients; (healthcare providers) create fake patients and say they’re providing services to people they don’t actually see,” Scanlan says. Another method is creating bills for actual patients who may have been seen for one condition or treatment and adding additional charges for treatments or evaluations at a later time that were never actually provided.
The patients often aren’t aware fraud is going on. “The patient doesn’t know any better. They don’t know what the doctor bills for,” Scanlan adds.
The healthcare providers and those working in these medical offices and hospitals are in a unique position to know about these fraudulent billing practices, according to Scanlan. “It’s got to be someone with access to the paperwork to show how this happens. It’s really difficult to prove these cases unless you can have somebody who says there’s just no way that this can happen.”
What can help prove these kinds of healthcare fraud whistleblower cases, says Scanlan, is someone who knows what services are being billed, the supposed number of patients and who also knows that those numbers just don’t add up. “There’s a person in the office who’s able to show this one doctor sees 85 patients a day and the billing codes for the service provided, there’s no statistical way one doctor can see that many patients in one day,” Scanlan says.
In representing her whistleblower clients, Scanlan frequently uses the federal False Claims Act (FCA) and state laws which make it possible to recover money for the government while also protecting the person trying to expose the fraud. She says the FCA makes it illegal for employers to retaliate against whistleblowers and may allow for monetary awards to relators (as they are known) under certain circumstances.
“There’s a lot of strategy associated with how to go about this,” Scanlan says, “If a person reports possible fraud to their employer, the whole dynamic shifts once it’s reported.” She advises anyone who suspects healthcare fraud by their employer and who wants to report it first contact an attorney to learn about applicable laws and their rights.
“There’s a lot of information and a lot of things a whistleblower can do . They need to understand what their best options are, whether they should report it or not report it and to whom they would make the report. These are all critical questions and you only get one shot at doing it right. That’s why we want people to talk to a lawyer first.”
The entire Google+ hangout interview with Scanlan can be viewed on YouTube. Upcoming Google Hangouts from Keller Grover will explore more dimensions of how whistleblower laws are leading the fight against fraud — and how whistleblowers can lead the charge. For more information about how the Keller Grover law firm assists whistleblowers in beating back fraud, contact the firm’s lawyers at ReportGovFraudNow.com or call its Whistleblower Helpline at 866-486-1537.
Media Contact:
Kathleen Scanlan
866-486-1537
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