Defending a Medicare or Medicaid Fraud Claim
Medicare and Medicaid fraud reportedly cost the Federal government billions of dollars each year. Last year, the Federal Government recovered an estimated 4.1 billion dollars in fraudulent healthcare payments. If you are a healthcare provider, you know that Medicare or Medicaid billing errors or mistakes can not be taken lightly.
If you are accused of Fraudulent Medicare or Medicaid billing practices, it is important to understand that you face serious consequences including the loss of ability to participate in government programs, criminal charges, and the loss of your professional license.
A Medicaid or Medicare fraud investigation may stem from an accusation that you:
- over-billed for services provided and/or billed for services not rendered;
- falsified information or provided false information;
- provided services that were not medically necessary; and/or
- unlawfully received benefits.
In order for a health care facility or doctor to be convicted of fraud, the government must establish that the “errors” were intentional.
This can be a difficult task because Medicare and Medicaid are governed by strict regulations that can be difficult to understand. Given the difficulty, unintentional mistakes are common when filing paperwork or completing billing information.
According to Health and Human Services (“HHS”), increased Medicare and Medicaid recovery efforts resulted in a 50% increase in judgments and payment settlements between the years 2009 and 2011.
The Federal government is also cracking down on health care fraud.
Heath Care fraud is a type of white-collar crime that involves filing a dishonest claim to turn a profit. Health care fraud can include fraudulent billing for services.
Common accusations include:
- billing for services not rendered;
- rendering an unnecessary service;
- prescribing the use of unnecessary medical equipment, or medical procedures;
- receiving kickbacks or engaging in self-interested referrals.
