The Medicare fraud recovery team at Mahany Law is investigating a complaint of Medicare fraud involving North Atlanta Primary Care. A patient reports billing improprieties that suggest that the practice is engaged in “upcoding.”
Upcoding occurs when a physician or clinic uses an inaccurate billing code to increase the amount of remuneration owed. For example, let’s say a radiologist X-Rays your thumb and the amount insurance will pay for such an X-Ray is $50. Upcoding occurs if the physician charges as if she took a picture of the thumb, hand and wrist.
Upcoding can also occur if a physician’s assistant bills as if he is a physician. (Doctors are paid more than physician assistants and nurse practitioners.)
Why We Are Investigating North Atlanta Primary Care
Upcoding is fraud. It is illegal in all fifty states and under federal law. In certain cases, it can even be considered criminal.
Some people believe Medicare fraud is a victimless crime. They are wrong. Since tax dollars pay for Medicare and Medicaid, upcoding means that taxpayers are footing the bill. If upcoding occurs with private insurance, that simply means that those phony charges are being passed along to the premiums we pay. Either way, healthcare fraud isn’t victimless.
If Medicare, Medicaid or Tricare is involved, the U.S. Department of Justice can pay cash awards to whistleblowers with inside information. And there is where we need your help.
Although patients can be whistleblowers and can receive rewards, most successful whistleblower reward cases are brought by insiders. By “insider” we mean present or former healthcare workers including nurses, doctors and billing technicians. Unfortunately, although patients may have evidence of questionable bill, they typically don’t have enough knowledge to show a “pattern and practice” of fraud.
Although we don’t have enough information to proceed, we might be able to put together a winning whistleblower rewards case with the help of an insider.
Under the federal False Claims Act, whistleblowers can receive between 15% and 30% of whatever the government recovers. Million dollar recoveries are common.
We don’t know much about North Atlanta Primary Care. According to their website, they have 11 offices and are based in Alpharetta, Georgia.
Their offices are in Alpharetta, Braselton, Cumming, East Cobb, Johns Creek, Marietta, Midtown, Sandy Springs, Sugar Hill, West Paces and Woodstock. The company is run by Thomas Bat, M.D., Bob Nichols, COO and the clinic’s CFO, Rod Rusyniak. None of those individuals are suspected of any wrongdoing.
We stress that a single claim of upcoding doesn’t mean that any fraud is taking place. We really hope to speak with present and former employees of the practice.
Speaking of former employees, employee ratings as found on the employment site indeed.com give us plenty of concern. Many of the ratings suggest a culture that puts profits before patients. We also learned that some employees believe they are working off the clock and without pay. (Not paying time and one half for workers who work more 40 hours pay week may violate the Fair Labor Standards Act, another law that pays damages when employers try to cheat the system.)
To learn more, visit our Medicare fraud whistleblower information page. Ready to help or see if you may be eligible for an award? Contact attorney Brian Mahany online, by email or call 202-800-9791. Cases handled nationwide.