Search Site
Menu
Whistleblower: Medicare Advantage Overcharged for Home Visits

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.

A lack of accountability

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.

Leave a Reply

Your email address will not be published. Required fields are marked *

Honors
Our Office
  • Dallas Office
    4514 Cole Ave
    #600
    Dallas, Texas 75205
    Phone: 214-306-8045
    Fax: 469-729-9926
Testimonials
  • "Steve Kardell was terrific in representing me in some very adversarial discussions with Citigroup and also later represented me in my testimony before the Financial Crisis Inquiry Commission."  -Richard Bowen, Citigroup Whistleblower

  • "Incredible knowledge of employee related concerns and equally brilliant knowledge of health care regulations, standards of practice. I would recommend this firm to anyone."  -V.B.

  • "Reaching out to Steve Kardell was the best decision I made. His ability to provide immediate insight and direction was very powerful, and a huge relief during a very stressful time period. For anyone struggling with a whistleblower situation, I would highly recommend at least speaking with Steve. After a 10 minute call with him, I had a better understanding of what I was dealing with. Even better, he gave me some immediate hope. In the end Steve did a better job than I thought was possible. Steve was able to get in contact with people in my organization, that I didn’t have access to. Because of his years of experience, he already has contacts in many organizations in Dallas. The entire situation was handled peacefully. I was impressed by his ability to “keep the peace”–rather than creating a battle with the organization. The reason I didn’t reach out to a lawyer initially, was because I thought it would mean an immediate end to any hope of a positive relationship with the company. Steve was able to address my concerns, and in the end I was able to continue to work for them."  -KS

  • "Never thought my career would end like it did after 30 years of service. I was part of the first round of the so called reduction of force. I asked myself how can I be part of this with 30 years of seniority. How did they pick these 90 plus employees? Now, the culture of this organization made you question every decision they made. It wasn’t what you knew it’s was a culture of who you know. Nonetheless, I did not accept their severance package. I immediately starting looking for an attorney who would take on my case. After the initial call to Steve I had hope again. He was open and honest about everything and reassured me he would do his best for me, and he did. I had an awesome outcome. Thanks Steve you’re the best."  -S.S.

FOLLOW US
Facebook Twitter Linkedin RSS Feed JD Supra