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Over $50 billion in Medicare claims per year are scrutinized as being potentially false or fraudulent. Like most types of fraud, Medicare fraud occurs when someone lies or uses false information or credentials to obtain money or benefits they would not legally be entitled to. Most cases involve improper billing and coding, but there are plenty of other ways to commit fraud with the Medicare system. This crime is a federal felony in all cases, so people who are facing these charges need to ensure that they have a reputable lawyer on their side for the best outcome.
Know What Medicare Fraud Looks Like
Common instances of medicare fraud include:
-Healthcare provider billing for services never rendered
-Provider inflating the cost of services rendered when submitting to Medicare
-Performing services that are not medically necessary for financial gain
-Over-prescribing medications or misrepresenting their necessity to receive higher Medicare payments
-Lying about a diagnosis to receive financial compensation for tests or treatment
-Waiving co-pays and deductibles that are unqualified and required by Medicare
-Billing for procedures separately when they were done in a single session
-Receiving kickbacks from a provider or facility for referring patients
This type of fraud is most commonly committed by healthcare providers, billers, and insurance representatives. However, it can be committed by patients just as easily. Patients may even be approached by providers to participate in a fraudulent scheme, where their assistance or involvement would be vital to the success of the scheme.
Punishment and Penalties
The Office of the Inspector General, along with many other health and government departments and organizations, will pursue and investigate all fraud claims. Those who are found guilty could be required to pay fines adding up to the thousands of dollars or face a federal prison sentence. Other penalties for fraud include: non-payment of future claims, exclusion from federal programs for healthcare, and civil fines and penalties.
In most types of fraud, intent must be proven in order to charge someone criminally. Unfortunately, in the case of Medicare fraud, the government doesn’t require nearly as much proof of intent. They don’t care if someone knew the law or not; they will file charges first and ask questions later. That is why it is critical to know the laws and regulations surrounding Medicare billing as a healthcare provider, facility, or other entity. Claiming that you “didn’t know” is not an acceptable defense here.
What Should I Do?
If you have been charged with Medicare fraud, the first thing that you need to do is contact a qualified attorney to discuss your case. They will help you craft a strong defense and advise on the best course of action in regard to the specific charges that you are facing. Lawyers understand the laws surrounding Medicare fraud and how to navigate the legal process, giving you the peace of mind that you will get the best outcome from your case.
You need a legal team that has industry knowledge, experience working with government entities, and that will work to keep charges at a civil level and reduce the charges and penalties as much as possible. The government will seek various penalties for defrauding the Medicare system, including fines and prison time as well as the potential punishments listed above, so you need an attorney that can take everything that the prosecutor is throwing at you and turn it around to work in your favor. The experienced Delaware County Medicare fraud lawyers at our practice know all about fraud within the Medicare and Medicaid system, including how to help you create a solid defense and get the best outcome from your case. Contact us today to learn more.