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What are common examples of Medicare fraud?

On Behalf of | Nov 10, 2022 | Criminal Defense |

Medicare is a federal program that provides a means for qualified individuals to receive medical care. Those who may qualify for this type of coverage are those who are age 65 and up, as well as those who have end-stage renal disease or certain types of disabilities. Without this type of health insurance, some in Kentucky may go without health care or face extremely high medical costs due to insufficient health care coverage. The federal government takes Medicare-related crime seriously. 

Defrauding the Medicare system is a grave criminal offense, and it is one that the government will prosecute to the fullest extent of the law. Medicare fraud can happen through misrepresentation, illegally receiving funds, lying on an application and more. If convicted of this type of offense, it could result in detrimental consequences, including significant time in prison.  

The ways Medicare-related crime happens 

There are various different types of Medicare scams and schemes that often focus on stealing funds or gaining access to the sensitive information of the recipient. These types of crimes can take many different forms, but illegitimate Medicare spending typically falls into the following four categories: 

  • Medicare abuse — This happens when a health care provider unwittingly files for a Medicare payment for which they are technically ineligible. Even inadvertent requests for non-deserved reimbursement are abuse of the system. 
  • Medicare fraud — This happens when pharmacists and other types of care providers intentionally and knowingly file illegitimate claims for reimbursement from Medicare. 
  • Medicare scams — This happens when someone impersonates a care provider in an effort to gain access to the recipient’s personal information. They may use this access to obtain funds for themselves or use the system for personal gain in other ways. 
  • Medicare waste — This happens when care providers overutilize different services, resulting in additional claims and unnecessary costs for the Medicare program. 

These different examples can take various forms, including fraudulent billing, lying on applications, providing unnecessary services, kickbacks and more. Medicare fraud cases can be difficult to investigate and prosecute. 

Are you facing charges? 

If you are facing allegations of Medicare fraud of any kind, it is in your interests to take immediate action to defend your interests. Through your carefully crafted defense plan, you may be able to fight the charges against you and ensure the protection of your constitutional right. By seeking experienced input regarding the ideal way to develop your defense strategy, you can take steps to confront the prosecution’s case and seek the best possible outcome to your case.