Admitting patients to the hospital when they could be treated on an outpatient basis
Upcoding lower cost services and procedures for higher ones
In addition, hospitals must submit and certify annual cost reports, to be reimbursed for certain costs relating to health care services provided to Medicare beneficiaries. Medicare cost reports include information about the hospital’s characteristics, information about services provided and procedures performed at the hospital, how much the hospital spent to provide those services, and how much revenue the hospital collected. If a hospital inflates or mischaracterizes costs, it can face liability for submitting a false claim.
Whistleblower Cases Involving Hospital Fraud
Whistleblowers have played a critical role in reporting hospital fraud under the False Claims Act and other whistleblower laws. A whistleblower may have information about hospital billing practices, coding procedures, medical recordkeeping practices, admission procedures, or financial arrangements between hospitals and others.