Can Medicare Fraud Happen to Any Organization?

Medicare Fraud lawyer

Medicare consists of public money that has been allocated to make sure that the most vulnerable people in society, the elderly, disabled, and the poor, are able to receive the medical care and medicine that they need. Unfortunately, millions of dollars of these health care funds are lost every year to corruption and fraud. Health care providers of all types have ample opportunity to take advantage of government resources like Medicare. With the help of Medicare fraud lawyers, this can change.

What Is Medicare Fraud?

Medicare fraud can happen at any organization that receives federal funding, including (but not limited to):

·      hospitals

·      nursing homes

·      clinics

·      assisted living facilities

·      Health Maintenance Organizations (HMOs)

·      medical equipment providers

·      home health care providers

·      ambulance and emergency medical service companies

Medicare covers qualified persons in four major areas: hospital insurance, prescription drugs, medical insurance, and Medicare advantage plans. Each of these benefits is subject to fraud. Medicaid is a need-based medical insurance program for people with low incomes and few assets that is funded by both the state and federal governments. Like Medicare, it is a frequent target of fraud. Most Medicare and Medicaid fraud includes doctors, dentists, hospitals, clinics, pharmacies, nursing homes and other health care providers who are involved in the following types of violations:

·      billing for services not performed

·      over-billing for services provided

·      kickbacks and self-referrals

·      padding mileage accumulated on ambulance trips

·      billing for professional services provided by individuals without proper credentials

·      creating fraudulent cost reports

·      billing for unnecessary tests, services, and products

·      prescribing and billing unnecessary drugs or medical equipment

·      prescribing or billing medical equipment which is not provided

·      charging brand name prices for generic drugs and medical products

·      diluting drugs

·      billing for appointments that were not made or were cancelled in advance

What Can Be Done?

 Medicare and Medicaid fraud is a federal offense, and several laws are in place to combat it, such as Anti-Kickback laws and the Stark Law. 

Anti-Kickback Statute

There are more federal laws than the False Claims Act (“FCA”) that protect the government from fraudulent behavior. The Anti-Kickback Statute, prohibits individuals from offering, paying, asking for, or receiving anything of value to induce or reward referrals or general federal health care program business. Many illegal kickbacks are payments, some of which are hidden through various false transactions between people or businesses. However, illegal kickbacks can also be gifts, like expensive sporting event tickets or vacations under the cover of professional conferences.

Individuals who are found to have given, offered, received, or solicited illegal kickbacks within the health care industry can face civil fines and criminal penalties. For each violation of this statute, an individual can be sentenced to up to five years in prison.

If you know of bribes being paid between physicians, other health care providers, or medical device providers, contact a Medicare fraud lawyer today.

Stark Law

This law states that, it is illegal for a physician to refer Medicare patients for certain health services to a facility with which the physician or one of his or her immediate family members has a financial relationship, unless a specific exception applies. If a doctor does refer a Medicare patient to a facility with which he or she has a financial relationship, that facility cannot submit a claim to Medicare for the relevant services.

This law is intended to stop physicians from referring patients to businesses if the physician will ultimately profit from the patients going there. The purpose of the law is to ensure that physicians focus on what is best for their patients and not the financial aspects of providing care.

Physicians who violate this statute, either in making illegal referrals or submitting a claim based on a prohibited referral face civil consequences, including high fines.

If you are aware of a physician or facility making or accepting referrals in violation of Stark Law, speak with a Medicare fraud lawyer.

For More Information

To find out more about Medicare fraud and the Laws that govern it, please seek advice from an experienced Medicare Fraud lawyer such as The Morales Law Firm.