A whistleblower case in Texas has come into the spotlight with allegations that a medical consulting firm is overbilling Medicare for in-home patient examinations.
The details of the case were unsealed in June, and it’s only the latest of at least six other whistleblower claims filed in the last five years alleging billing fraud by Medicare Advantage plans. These plans have been popular with elderly patients.
This particular lawsuit was filed in a Dallas federal court last year by a medical billing coder named Becky Ramsey-Ledesma, a former employee of CenseoHealth LLC. The firm has contracts with thousands of doctors who pay elderly patients in-home visits to conduct health evaluations on behalf of Medicare Advantage.
According to allegations in the lawsuit, the health assessments these doctors made regularly exaggerated how sick the patients were, which led to overbilling Medicare to the health plans. There are 30 different Medicare Advantage plans across 15 states named in the lawsuit, including plans from Humana and Blue Cross Blue Shield.
Medicare Advantage plans have boomed in popularity within the last few years and cover approximately 17 million people throughout the nation. Private insurance plans act as an alternative to regular Medicare for seniors, which pays doctors for each rendered service. Medicare Advantage plans, on the other hand, receive a set fee every month per patient based on a score that pays out higher amounts for sicker patients. By exaggerating illnesses, healthcare providers can receive more funding.
For more information on how you can file a whistleblower complaint if you are aware of misconduct in your company, consult knowledgeable Dallas Attorney Steve Kardell at Whistleblower Law for Managers.