Reporting clinical laboratory services fraud and how to report lab test fraud for a reward
Doctors frequently order lab test, such as blood test, when diagnosing or treating Medicare or Medicaid patients. Unfortunately, some medical laboratory-testing companies cheat or defraud Medicare and Medicaid through a variety of fraud schemes. Without the help of whistleblowers, lab test fraud often goes undetected. That’s because Medicare pays 100% of lab fees and Medicare does not require lab test companies to submit the medical diagnosis or other information showing the need for the lab tests.
This article shows you how to get a reward for reporting Medicare/Medicaid fraud by reporting clinical laboratory services fraud (lab fraud). Below are examples of fraud by medical laboratory-testing companies followed by tips for reporting lab test fraud, and how to obtain a reward.
Examples of clinical laboratory services fraud (lab test fraud): lab tests not medically necessary or not ordered by a doctor or not performed
Medicare and Medicaid only reimburse lab test companies for lab tests that are reasonable and medially necessary. One common lab test fraud scheme is for a medical lab testing company to add tests that were not ordered by the physician. The doctor often is unaware of the lab test fraud because the laboratory performed the needed test. A variation of this fraudulent scheme is that the lab doesn’t actually perform all of the tests that it bills to Medicare.
Examples of clinical laboratory services fraud (lab fraud): unbundled lab tests
It is also lab test fraud for a medical laboratory-testing company to unbundle a panel or group of tests and bill them separately. For instance, a lab test company offers a panel or group of lab tests that generally are needed at the same time for certain suspected illnesses. The lab company charges less for the set or panel of tests than if a doctor ordered all the lab tests in the group separately. Medicare can only be charged or billed the panel or group rate for these test. Unfortunately when a doctor orders a panel or group of lab tests, some lab test companies split out or unbundle some or all of the tests and bill them separately and higher rates than allowed under the Medicare program.
One large company paid $325 million to the government to settle allegations that its medical clinical laboratory fraudulently billed Medicare for unnecessary blood tests. The allegations included that the lab test company deliberately overcharged Medicare for blood tests that were not ordered by doctors, and that the lab test company unbundled or billed separately for blood test panels or groups.
Tips for reporting clinical laboratory services fraud (lab test fraud)
It is not enough to call a Medicare or Medicaid fraud hotline to get a whistleblower reward for reporting clinical laboratory services fraud (lab fraud). Instead, you must formally apply for a whistleblower reward for reporting clinical laboratory services fraud by having your attorney (on a contingency basis) file a qui tam suit under the False Claims Act.
In addition, your attorney must strictly follow the exacting procedures of the whistleblower reward statute to get a reward for reporting Lab testing companies cheating or defrauding Medicare or government healthcare programs through clinical laboratory services fraud (lab test fraud).
Moreover, you also need to have specific and detailed evidence of clinical laboratory services fraud. The government needs your help in uncovering fraudulent billings in clinical laboratory testing services. However, because most whistleblower reward applications lack specific proof of fraud (or contain another defect), the government turns away most reward applications. That’s why selecting an experienced attorney that has handled many Medicare fraud cases is very important.
How much reward for reporting a clinical lab testing services fraud?
The amount of a whistleblower reward for reporting clinical lab test fraud is based upon the amount the government recovers back, and the reward is between 15% and 25% of what the government collects from the Lab company cheating Medicare. For instance, if lab test company charges or cheats Medicare by $100 million, the amount of the whistleblower reward could be between $15 million and $25 million.
How to report lab testing fraud
This website (and books written by Mr. Hesch) walk you step-by-step through the entire process of reporting clinical laboratory test fraud and shows you how to obtain a whistleblower reward.
Mr. Hesch has considerable experience with investigating Medicare fraud against the federal government while working for 15 years at the Civil Fraud Section of the U.S. Department of Justice in Washington, D.C., which is the office with nationwide authority over the whistleblower reward program. He now represents whistleblowers and confidentially reviews information to determine whether and how to report clinical laboratory services fraud.
The link below “Do I have a case” shows you how to ask Mr. Hesch to review your allegations that a clinical laboratory services company fraudulently billed Medicare for lab test fraud.