Medicare is an important federal program that provides assistance to a significant segment of the population. Millions of Americans rely on Medicare for health care access. Doctors and other medical professionals frequently accept Medicare payments for many types of services. Medicare can pay for an operation. It can also pay for physical therapy for arthritis, medications to treat high blood pressure and help with doing chores at home in the event that someone is disabled. Many health care providers know how to use Medicare to make sure their patients are covered for the treatment they need. They also know how make sure all payments are received in a timely manner. However, Medicare rules can be quite complicated and subject to frequent changes. Problems can arise under many circumstances. Sometimes, error may be made with payments. Government officials are charged with making sure that Medicaid is used as intended by the recipients and the providers.
Medicare fraud is generally defined as the act of knowingly and deliberately billing the government for services that were not rendered or were not necessary. There are many ways that a provider can engage in Medicare fraud. A provider may charge more for Medicare services than they would for other patients. They can bill Medicaid for services that were not provided. Some providers may be accused of billing for services that were not actually medically necessary. This may include procedures such as hearing tests or eye examinations that were conducted twice a year rather than once a year as recommended by major medical organizations.
It is possible for service providers to make mistakes when billing. For example, a doctor’s office may submit a bill for one medical procedure when another one was performed. Many terms are used to describe varied forms of Medicare fraud. Phantom billing is when a provider bills for services they did not perform. Upcoding is when a service provider bills for a more expensive procedure rather than the procedure they actually did for the patient. A provider may be accused of billing separately for services that should have been combined into a single bill. This is known as unbundling. Providers may be accused of billing twice for a single service. They may also be accused of charging for more expensive drugs while giving the patient generic versions that may not be as safe.
Even choosing which vendor to work with may create potential problems. For example, those who work with Medicare may also be accused of accepting money from an outside source such as a provider of medical devices. In turn, they have reached an agreement with that service provider to use only their products in the office rather than a competitor’s. A provider may also be accused of using Medicare funds for their own use rather than to provide patient care.
The misuse of Medicaid funds is considered a serious offense under state and national laws. Service providers may be facing heavy fines and potentially long prison jail terms if they are ultimately found guilty. This is why it is imperative that all providers who work with this program understand the program’s features. Proper staff training is the best course of action. It’s also crucial to make sure that all billing is submitted properly at all times. A single mistake can trigger a potential examination from government officials. Officials who are found in deliberate violation of Medicare policies can be banned from participating in the program for a period of time. Those who do so more than once may face a lifetime ban from accepting Medicare patients. This is why it is extremely important to fight any potential charges of misuse of Medicare fraud. Help from Chester County Medicare fraud lawyers can provide an effective defense and make sure that all health care providers can continue to offer valuable services to their patients.