by Brian Mahany
Doctors, nurses and health care workers deserve the utmost respect. 99% of them do a wonderful job, even in less than ideal conditions. Unfortunately, the Institute of Medicine says that hospital errors kill 100,000 Americans per year according to an article published by Yahoo Health. If that number is correct, that is the equivalent of a jumbo jet crashing every day, 365 days per year. If these numbers are even half true (one expert says they are far too conservative), hospital treatment errors represent the lion’s share of health care fraud claims.
If the hospital error mortality rates aren’t enough to scare you, consider this. Hospitals profit when they make mistakes. That’s right. They make more money when a surgery is botched or someone catches a hospital borne infection.
Hospitals bill insurance, Medicare and patients based on the care they receive. The more procedures or the longer the stay, the more they can charge. While there have been some successful efforts to reduce the length of hospital stays, most insurance carriers still bill by the amount of care given. Need a 2nd or 3rd corrective surgery? That’s another $20,000+ for the hospital.
We say billing for botched treatment is health care fraud. Hospitals and doctors shouldn’t get paid for making mistakes.
According to the same Yahoo Health article, one expert said that common medical mistakes caused 896,000 deaths in 2008. Said Carolyn Dean, MD, author of the book Death By Modern Medicine: Seeking Safer Solutions, “If medical error was a disease, it would be the leading cause of death in the US.”
Anytime a patient is billed for improper treatment, health care fraud exists. Some believe medical billing fraud is largely a victimless crime because insurance picks up most charges. That argument forgets that improper treatment kills people. You can’t put a price tag on the value of someone’s child, mother or brother.
People also forget that health care fraud directed at insurance companies and Medicare still hurts all of us. Insurance rates are so high that many people can only afford minimal coverage or rely on charity care. And Medicaid and Medicare? Those monies come from taxpayers. You and me.
Congress and the 50 states should take action and prevent hospitals and other medical providers from profiting off mistakes. While few doctors deliberately harm patients in the hope of making more money, there is no financial incentive to prevent mistakes.
Unfortunately, we are aware of some hospitals and medical groups that intentionally over bill or bill for unnecessary services. This too is health care fraud and in instances of improper billing and unnecessary treatment, there is a private right of action meaning whistleblowers can file suit on behalf of taxpayers and keep a portion of any monies recovered.
In order to qualify as a whistleblower and to collect a cash award under the false claims act, you must have inside, non-public information about a fraud which causes a loss to the government. Since Medicare relies on government monies, Medicare and Medicaid fraud is eligible for an award (typically 20 to 25% of any recovery).
Although legislators must still tackle the financial disincentives to providing quality care, whistleblowers have a strong ability to also fight health care fraud by identifying false billing. More importantly, unnecessary procedures frequently harm patients and sometimes lead to fatal complications. We have seen several false claims act cases (whistleblower cases) in which unnecessary cardiac stents procedures were done just to run up exorbitant fees!
If you have information about fraud against the government or misuse of tax dollars, give us a call. Our false claims lawyers represent whistleblowers in a wide variety of cases. For more information, contact attorney Brian Mahany at or by telephone at (direct). All inquiries are protected by the attorney – client privilege and kept in strict confidence.
Mahany & Ertl – America’s Fraud Lawyers. Offices in Milwaukee, Wisconsin; Detroit, Michigan; Minneapolis, Minnesota; Portland, Maine and San Francisco, California. Services available in many jurisdictions.
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