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Our firm has over 25 years of combined legal practice. Our Philadelphia criminal attorneys have been recognized by the top lawyer ranking services.
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We take on fewer clients than other firms. Each client works 1:1 on with one of our senior attorneys.
The healthcare industry is a very important industry that helps to ensure that all people are able to gain access to healthcare when they need it. One very important participant in this program is Medicare, which is a federal program that helps to ensure that millions of people get the care that they need and deserve. Today, many healthcare providers earn a large portion of their revenue from Medicare for providing important services.
In the majority of situations, a healthcare provider will bill Medicare for charges that are legitimate. However, there are situations in which someone could bill an inaccurate amount. Depending on the situation, this could constitute Medicare fraud.
Examples of Medicare Fraud
The most common type of Medicare fraud occurs when you bill for services that were not performed. If you had a patient come into your practice that you performed certain services for, any additional services that you billed for that were not performed would be considered a fraud. Other examples of this can include if you coded certain services differently to ensure they would either be covered or if they would be reimbursed at a higher amount.
Another serious example of Medicare fraud is if you performed medical procedures and services on someone that did not need the services. If it is determined that you did certain services that were not necessary simply to earn additional revenue, you could be charged with Medicare fraud.
Finally, if you were to accept kickback or bribes for taking certain patients, or for referring them to another specialist, it would be a clear violation of the law and you could be charged with Medicare fraud. This would also include if you paid money to another party in lieu of them referring a patient to your practice in order to boost your revenue.
If you are charged with Medicare fraud, there are a variety of charges that you could be facing as well. Since you likely will receive your Medicare reimbursement either through a check or through a bank wire, you could be charged with mail or wire fraud as well. Both of these can come with serious penalties as well since they are considered felonies and could be investigated by the FBI.
If you are charged with Medicare fraud, there are a variety of penalties that you could be facing. Depending on the scope of the fraud, you could be facing felony charges that would also come with imprisonment. In more minor cases, you could still be facing some significant financial penalties. At a minimum, Medicare will seek to be reimbursed for the amount that was deemed to be fraudulently earned plus expenses. In other situations, you could be billed for additional financial penalties.
For healthcare providers, another concern about Medicare fraud is that it could be very damaging to a business. Depending on the situation, you could end up losing your right to bill for Medicare. This could immediately reduce the amount of customers that you have and would be very damaging to your business. If you happen to have provided care that was considered negligent or not necessary, you could also face losing your medical practice license entirely.
If you are charged with Medicare fraud, ensuring that you have proper legal support is very important. A Medicare fraud attorney can provide you with a variety of services to ensure your rights are represented and that you make the right choices for your situation. An experienced Medicare fraud attorney will be very familiar with the different types of Medicare fraud and how to defend these cases. In many situations, the attorney will be able to work with the other parties to negotiate a lower charge, which could help to drastically reduce the potential penalties that you are facing.