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What is Medicare fraud?

On Behalf of | Mar 28, 2024 | Criminal Defense |

Medicare fraud is a serious offense that can cause life-changing repercussions with a conviction. Those who work in healthcare, especially when dealing with Medicare cases, must be particularly careful to follow the regulations when filing paperwork and completing other Medicare-related tasks. Healthcare workers already have many stresses when it comes to doing their jobs each day without being accused of fraud. Understanding Medicare fraud can help you understand how to avoid these types of accusations and give you information on what to do if you are accused of committing Medicare fraud.

Common types of Medicare fraud

Many Medicare fraud accusations are based on billing practices. As a healthcare worker, you likely work hard to ensure that your paperwork is filed properly so that the patient’s medical bills reflect the treatment they received. Double billing, where a patient is charged twice for medical care, is a common type of Medicare fraud. Phantom billing, where the patient is charged for a procedure that did not occur, is also considered fraudulent.

Other types of Medicare fraud are related to upcoding, where a procedure is improperly coded to increase the billed costs of the procedure. Unbundling, where bundled procedures are separated so they can be billed separately, is also fraudulent. Receiving kickbacks, performing unnecessary procedures and not keeping the required medical documentation can also fall under Medicare fraud.

What to do if you’re accused

An accusation of Medicare fraud could harm your reputation, leading you to lose your job as a healthcare provider. Even when you’re accused and not yet convicted, others in your field may ostracize you, and you may have trouble finding a new job in the future. When accused of fraud, it’s important to seek legal advice promptly. You’ll need to have information about the specifics of the accusations so you’re able to defend yourself against those accusations.

As a healthcare worker, you’re likely under a lot of pressure to maintain records and keep everything documented as required. Healthcare workers are human, which means, like everyone else, mistakes do happen. Honest mistakes related to Medicare filing, billing and procedural work don’t necessarily mean that fraud was committed. Know that you will be allowed to present your evidence to give your side of the events that happened.

Seek legal advice

Fraud in the healthcare industry is taken very seriously, as it can affect patients, healthcare workers and insurance companies. Facing charges of fraud can be scary, but you’re not alone. Seek the advice of someone knowledgeable in Medicare fraud cases so that you’re prepared to defend yourself against the charges.