Private Whistleblowers Help Fight Healthcare Fraud

The Primer on Whistleblowing in Healthcare, co-authored by Atlanta attorney Jay Brownstein, is an excellent resource regarding healthcare fraud. Healthcare fraud, including false and deceptive billing practices, costs taxpayers upwards of $80 billion each year. Healthcare fraud comes in many shapes and varieties, including fraudulent billing, kickback schemes, and other illegal practices. With Medicare and Medicaid paying the majority of these expenses, taxpayers ultimately pay the bill for healthcare fraud.Healthcare Fraud Spends Tax Dollars

In their article, Jay Brownstein and Kevin Little educate the public on what whistleblowing is, how it relates to the area of healthcare fraud, and what to do should healthcare fraud be suspected. They point out that healthcare providers and employees need to be aware of their rights, as there are many state and federal laws in place to protect them in whistleblowing instances. Additionally, an outline of what to look for in billing fraud, illegal referral fees or kickback schemes, and drug manufacturer or medical device fraud is included. The article also identifies steps to take to help protect oneself before reporting fraud or wrongdoing in the healthcare industry.

Each year, many courageous private citizens bring qui taim, or whistleblower lawsuits, to help the government recover billions of dollars in fraudulent healthcare claims. The Primer on Whistleblowing in Healthcare is a quick, informative read for those interested in the topic.

Shocked by those hospital bills? You are not alone.

Have you ever looked at a hospital bill with utter disbelief? You are not alone. Medical bills are the number one cause of personal bankruptcy filings in the United States. The cost of hospital care can be extraordinary, especially in light of the fact that many hospitals are operated as non-profits. Exacerbating the problem is the fact that most often patients in need of urgent care have no ability or opportunity to comparison shop. Hospitals essentially operate free from market constraints.

Medical BillsIt has recently come to light that due to the manner in which hospitals establish pricing for services, the retail or gross charges to patients (before insurance payments or discounts) are entirely arbitrary. Last year, author Steven Brill outlined some of the exorbitant costs of medical care in an important Time magazine special report titled “Bitter Pill”. Using the specific examples and powerful personal narratives of ordinary people who have suffered from unreasonably high medical expenses, Brill has exposed previously hidden truths about our healthcare system that help unravel the mystery of spiraling healthcare costs. Hopefully, Brill’s research and undeniable conclusions will help create a level playing field for the general public and policymakers in understanding how to combat and perhaps one day solve the problem.

One element of Brill’s research that seemed the most surprising was the existence and function of a hospital “chargemaster.” Before “Bitter Pill,” most of us had likely never heard of a chargemaster. As the name hints, a chargemaster is responsible for assigning the retail charges for all medical procedures, services, medications and supplies at a hospital. Using supporting visual references such as hospital bills and receipts, Mr. Brill does a superb job of documenting how charges can vary depending on a patient’s coverage. One example he uses is that of a chest X-ray in which a patient was charged $333.00. The same X-ray is covered for a Medicare patient at a rate of $23.83. Another example is a case in which a patient is charged $1.50 for one acetaminophen tablet (acetaminophen is the main ingredient found in the brand name painkiller Tylenol). The price for one tablet is in the same ballpark as what an entire bottle of the generic drug may be purchased for.

Bitter Pill is a great stepping stone into the discussion of fraudulent billing. More information can be found regarding the matter of fraudulent billing of Medicaid in the Primer on Whistleblowing in Healthcare , an article co-authored by Brownstein & Nguyen attorney Jay Brownstein. An experienced attorney who handles complex litigation matters, Jay Brownstein has consulted and represented clients in whistleblower cases. If you suspect that you have been overbilled or “up-coded” as a result of a hospital or nursing home stay, contact our trusted Atlanta attorneys for a free consultation regarding healthcare whistleblowing.

Healthcare-Associated Infections

Hospital care is often required for those who are ill or injured. However, there are unseen dangers involved in our healthcare system according to a recent report from the Centers for Disease Control (CDC). This report detailed the prevalence of healthcare-associated infections (HAI) that can be contracted during the course of hospital care.

Hospital infections and medical malpracticeIt is amazing that in 2014 it is still possible to contract an infection as a result of a lack of hand washing. However, the numbers reported in recent studies show that healthcare-associated infection is more than just a possibility – it is a danger all hospital patients face. According to CDC Director Tom Freyden, more than 200 Americans will die each day as a result of an infection contracted during a hospital stay. Freyden goes on to state: “The most advanced medical care won’t work if clinicians don’t prevent infections through basic things such as regular hand hygiene. Health care workers want the best for their patents; following standard infection control practices every time will help ensure their patient’s safety.”

The Multistate Point-Prevalence Survey of Healthcare-associated Infections, published in the New England Journal of Medicine, reports the most common infections related to hospitalization. These include pneumonia, surgical site infections, gastrointestinal infections, urinary tract infections, and bloodstream infections. While not all of these infections result in death, it is certain that these infections make recovery from surgery, illness, or other reasons involving hospitalization, more difficult.

Infections that result from a lack of hand washing and other preventive measures or safety issues such as unsterilized equipment, unsafe handling of blood and other substances, etc. may fall in the category of medical malpractice. Medical malpractice claims in Georgia are difficult to pursue, but the attorneys at Brownstein and Nguyen in Atlanta have extensive experience in litigating these types of cases. If you or someone you know has suffered from a serious infection as a result of medical malpractice or negligence, contact our Georgia malpractice attorneys for a free consultation today.