Are you concerned about being accused of Medicare fraud or abuse?
If so, you might be curious to know more about examples of Medicare fraud and abuse, because making this mistake could cost you dearly.
So what is Medicare fraud or abuse?
Simply put, if you claim Medicare health care payments or reimbursements which you don’t deserve, or to which you aren’t entitled, that constitutes Medicare fraud.
According to the National Conference of State Legislators (NCSL), Medicaid fraud “involves knowingly misrepresenting the truth to obtain unauthorized benefit.” Medicaid abuse “includes any practice that is inconsistent with acceptable fiscal, business or medical practices that unnecessarily increase costs.”
The NCSL goes on to say that Medicaid fraud, abuse and waste cost states billions of dollars each year, diverting funds which otherwise could be used for legitimate health care services:
“In 2015, improper payments alone—which include things like payment for non-covered services or for services that were billed but not provided—totaled more than $29 billion according to the Government Accountability Office.”
Another example of Medicare and Medicaid fraud is compound pharmacy fraud. This can involve overbilling federal agencies from health care services and products, submitting false claims for payments to Medicare or Medicaid, and paying kickbacks to physicians to get more compound pharmacy prescriptions.
Medicare fraud also may mean billing the federal government for products, procedures or services which weren’t truly needed for a patient’s treatment, or charging for such things when they weren’t, in fact, provided.
How Common is Medicare Fraud and Abuse?
In June, it was reported that the US Department of Health and Human Services made around $90 billion in improper payments to Medicare and Medicaid programs in 2017.
Also, the federal government’s Office of Management and Budget noted nearly $48 billion in improper Medicare payments in another recent year, though some of those payments eventually turned out to be valid.
As you can see, you might be accused of Medicare fraud when no such fraud actually existed. If so, you will need an experienced Texas health care fraud attorney, especially if you run a health care business that’s accused of Medicare fraud.
The Neal Davis Law Firm is experienced and knowledgeable in providing a strong legal defense against Medicare fraud and Medicare abuse charges.
Notify our law firm today of your situation, and we’ll provide you with a confidential legal review of your case. Then, you can decide if you want to hire a health care fraud lawyer from our firm.
In doing so, you should know the important distinction between Medicare and Medicaid, which also can be a source of fraud and abuse.
Medicare vs. Medicaid
Medicare is a federally supported health insurance program for all citizens age 65 or older. Certain people younger than age 65 can qualify for Medicare too, including those with disabilities and those who have permanent kidney failure.
Medicaid is health care coverage that’s designed for low income people and those with disabilities, and it’s a joint program by state and federal governments.
Medicare and Medicaid Fraud Penalties
Different types of fraud and abuse can lead to different punishments, some of them severe. These can include fines of $50,000 for each violation, which could be an enormous sum with multiple violations.
If you need a health care fraud defense lawyer, you’ve come to the right place. Contact us today for your case review, and let’s get started protecting your legal rights against charges of Medicare fraud or abuse.