One of the most significant drivers of skyrocketing healthcare spending is the escalating costs of hospitalization and emergency room services. The average cost of an in-patient hospital stay has climbed over $2000 per day, while the median ER visit now costs 40% more than what the average American pays in monthly rent.
With those high costs comes the temptation for providers to commit fraud, waste, and abuse. Indeed, one of the primary reasons for the rise in health care costs has been the large volume of fraud committed against government health care programs, such as Medicare and Medicaid, on which so many patients rely to pay their hospital and emergency room bills.
Billions of dollars in health care fraud have been exposed, largely through the efforts of qui tam whistleblowers acting under federal and state False Claims Acts. Businesses and individuals have devised various schemes to defraud government health care programs. Examples of such fraudulent conduct include:
- Services Not Rendered: A provider submits a claim for diagnostic tests, treatments, or other health care services that were never rendered to the patient. A related fraud occurs when a provider bills for time not spent admitted in a facility, such as when a doctors writes an admission order late one day, but the patient does not enter the room until after midnight.
- Ghost Patients: A provider submits a claim for diagnostic tests, treatments, or other health care services for a patient who either does not exist or who never received the services billed for in the claim.
- Kickbacks: The federal Anti-Kickback Statute prohibits any offer, payment, solicitation or receipt of money, property, or remuneration to induce the referral of patients for services payable by a government health care program. These improper inducements can come in many different forms, including, but not limited to referral fees; finder’s fees; productivity bonuses; discounted leases; discounted equipment rentals; research grants; speaker’s fees; excessive compensation; and free or discounted travel or entertainment. Offering, paying, soliciting, or receiving kickbacks is not only a federal crime under the Anti-Kickback Statute, but it also may violate federal and state False Claims Acts.