Hospital Inpatient Fraud
Serving Clients Nationwide
For any medical treatment to be legally covered under Medicare, it must be verified and documented to be medically necessary. Failing to adequately verify and document the medical necessity of claims billed to Medicare can be considered Medicare fraud as a violation of the False Claims Act. While the government understands the need for healthcare professionals to order or perform any service they deem appropriate, the law dictates that Medicare and other government healthcare programs should only pay claims for treatment that meets the relevant medical necessity standards.
Hospitals have a responsibility to inform their healthcare professionals about the medical necessity requirements for Medicare and other government healthcare programs. In addition, hospitals must be able to present documentation of medical necessity upon request, which requires them to fully inform physicians of the need for documentation and to properly retain that documentation. These requirements are intended to prevent Medicare fraud as some hospitals have been known to admit patients for inpatient care and provide inpatient services that are not medically necessary.
Becoming a Whistleblower on Hospital Inpatient Fraud
If you have knowledge that a hospital is admitting patients unnecessarily, billing Medicare for medically unnecessary services, or not properly documenting the medical necessity of Medicare-covered treatments, you have the opportunity to become a whistleblower under the False Claims Act by filing a qui tam lawsuit, and provisions of the False Claims Act work to ensure certain whistleblower protections from retaliation.
Whistleblowers who report hospital inpatient fraud serve an important function by helping the government recover scarce Medicare funds, and they can receive between fifteen and thirty percent of the amount recovered as a whistleblower reward. The public interest law firm of Kenney & McCafferty has been representing whistleblowers in qui tam cases for over fifteen years, giving us the experience to achieve a successful result and to maximize your whistleblower reward.
Kenney & McCafferty’s qui tam attorneys are part of a dedicated team whose reputation for excellence in nationwide and international whistleblower cases is well established. In recent years, we have been involved in some of the largest recoveries in the history of the False Claims Act.
If you have knowledge of a fraud or false claim against the government, please contact our qui tam lawyers today. Kenney & McCafferty attorneys will consult with you about your case, without obligation. All communications with Kenney & McCafferty attorneys during these consultation services are confidential and protected by the attorney-client privilege.