Whether through omission or commission, health care providers regularly overbill Government Health Care Programs. This message has been echoed, time and time again, in audit reports from the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG).

In the most recent audit report, HHS-OIG found that the audited providers overbilled Medicare 75% of the time. In a sample size of 1,290 line item payments involving Medicare outpatient services from January 2006 through June 2009, providers improperly billed Medicare 969 times, for more expensive treatments and for unallowable services.

Interestingly, the Medicare contractor that processed these claims did not flag a single improper payment. In other words, all 969 improper claims sailed through the payment system without a single denial or demand for refund. Indeed, these wrongful claims only came to light during the HHS-OIG claim-by-claim audit. The Medicare System needs courageous whistleblowers to step forward and fill this protective void by identifying Medicare fraud. Otherwise, our Government Health Care Programs are in jeopardy.

For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, P.A.