How Patients Earn Whistleblower Rewards by Studying Their Explanations of Benefits (EOBs)
Most people think whistleblowers have to be company insiders. That is not always the case. We often represent patients who discover overbilling on their Medicare Advantage Plan’s Explanation of Benefits (EOB) forms. By paying attention to those EOBs, patients can help the government uncover massive frauds.
Plus, as whistleblowers, patients can earn rewards worth hundreds of thousands of dollars and, sometimes, even millions of dollars.
Take the recent case of two men who submitted more than $3.8 million in false claims to Medicare Advantage and Medicaid managed care plans.
The owner and manager of a durable medical equipment supplier in New York billed Medicare Advantage and Medicaid managed care plans for hundreds of expensive patient support systems. These support systems included large devices that were designed to assist with lifting immobile patients and patients in nursing homes.
The men, however, did not actually provide the expensive support systems. Instead, they gave patients recliner chairs that had a seat lift feature. Between December 2010 and February 2014, the two men fraudulently billed Medicare Advantage and Medicaid managed care plans more than $3.8 million and were paid approximately $2.4 million.
It is almost impossible for the government to discover this type of fraud on its own. Every year, the government processes 1.2 BILLION fee-for-service claims for more than 33.9 million Medicare beneficiaries who receive health care benefits through the Original Medicare program. That is more than 3,000,000 (Three Million) claims every day. And that doesn’t include claims for reimbursement processed by Medicare Advantage, Medicaid, and Medicaid managed care plans.
With such a large number of claims being filed every day, the government cannot check every delivery to find out what the patients actually received. That’s where the patients come in. To ensure that patients are actually receiving the products and services that the government is paying for, the government needs patients to review their EOBs.
Most people only look at the EOBs to find out how much they have to pay. If the number is small or zero, they don’t bother looking at the details. Fortunately, our clients take the time to look at the details.
Over the years, our clients have earned millions of dollars in whistleblower rewards uncovering fraudulent billing for durable medical equipment, dental procedures, hyperbaric oxygen therapy, home healthcare services, urgent care center treatment, pharmaceuticals, and many other healthcare products and services.
So, what happened with the two men who fraudulently billed the government for expensive support systems when they were delivering only recliner chairs? They have been convicted and have to pay back all the money they received plus penalties.
If you have evidence of false or inflated claims being submitted to your Medicare Advantage plan, you should consult with an experienced whistleblower lawyer right away. You may be entitled to a whistleblower reward of between 15% and 30% of the amount the government recovers. But do not delay. Only the first whistleblower is entitled to a reward.
To schedule a free and confidential consultation with an experienced whistleblower lawyer, call us today at (212) 601-2728.
John Howley, Esq.