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The Health Insurance for the Aged and Disabled Program is commonly known as the Medicare program. Medicare is a federal program that seeks to provide health insurance coverage to individuals who are disabled or 65 years old or older. It has four parts that are used to cover separate medical expenses. In Montgomery County, you can be accused of medicare fraud if you allegedly violate any of the program’s rules.
What is Medicare Fraud in Montgomery County?
Medicare fraud refers to submitting fictitious or false claims to the federal health care program. The purpose is to bill the federal government for medical expenses a person didn’t incur. You may be accused of Medicare fraud in three ways according to the federal statutes 42 U.S. Code 1395h and 42 U.S. Code 1395u. You may be accused of Medicare fraud if:
1. You knowingly submitted false medical statements or made misrepresentation of fact to obtain health care payments which you weren’t entitled.
2. You made refers to certain designed health services to specific physicians or to their immediate family (the family must have financial interest, ownership or will be compensated). The referrals are made to receive some financial compensation. It’s known as a self-referral.
3. You knowingly paid, solicited or accepted any form of compensation for services or items reimbursed to them by Medicare.
4. You are accused of accepting civil monetary penalties because of submitting claims that you knew or should have known were false. You knew or should have known that Medicare would not reimburse for that particular service or item. This is called a violation of the Anti-Kickback statute.
5. You willfully or knowingly attempted to or actually committed a scheme to defraud Medicare. This means you are accused of presenting a medical situation under fraudulent or false pretenses.
Penalties for Medical Fraud in Montgomery County
If you are accused of medical fraud, you won’t face time in state prison. Instead, you face time in federal prison because Medicare is a federal crime. The exact time in prison depends on the seriousness of your case and if you have any prior criminal history. You may be ordered.
to pay civil fines such as $11,000 per false claim.
Build a Successful Defense with Our Help
To have a successful practice helping medicare patients may cause the government to assume you are committing Medicare fraud. You may be audited and/or charged with Medicare fraud. This means you can be targeted for Medicare fraud and be completely innocent of the charge.
It is important to note that the federal government doesn’t require intent to prove medicare fraud. This means that unlike other criminal cases prosecutors won’t have to show you intended to commit Medicare fraud. You still have a variety of defenses to use to prove your innocence.
Contact us for help with your Medicare fraud case in Montgomery County. We understand how the Medicare fraud laws work. We will defend you my attacking the specific elements that you are accused of committing. This means that we attack the elements involved in an Anti-Kickback violations or false claims Medicare charge.
In addition, we use of industry knowledge to build a strong defense for you. We understand that a medicare fraud accusation typically stems from coding and billing errors. Thus, you need a law firm who knows CMS protocols. We also have experience in negotiating with the government. This means that we understand how the federal government operates when accusing people of medicare fraud. Thus, we can challenge any claims made with tough evidence.
If you or your loved one is charged with Medicare fraud, do not hesitate to contact us. We are here for you. Contact us today for legal assistance in your Montgomery County fraud case.