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If you find yourself in the midst of an investigation arising from an allegation of Medicare fraud, or if you have been charged with this crime, you must take a proactive stance. Never underestimate the seriousness of a criminal prosecution for Medicare, or Medicaid, fraud. There are a number of crucial considerations that you need to bear in mind when you face this type of criminal prosecution.
Types of Medicare Fraud
Although Medicare fraud can, and does, come in a number of different forms, there are four general types of categories into which these cases fall. First, phantom billing is a major type of Medicare fraud in this day and age.
Phantom billing involves billing Medicare for procedures or treatments that were never actually performed. The patient may actually exist, but the procedure or treatment for which Medicare reimbursement is sought is a phantom. It never occurred.
Second, up-coding is another common type of Medicare fraud. Up-coding involves inflating bills submitted to the Medicare program for reimbursement. This is accomplished by utilizing a billing code for a procedure or treatment than the code associated with the procedure actually undertaken.
Third, yet another type of Medicare fraud involves recommending expensive treatments or procedures for patients that are unnecessary. The treatments or procedures actually are performed, and billed to Medicare.
Finally, there are Medicare fraud schemes of different types that involve the patient. The healthcare provider gives a patient a kickback of the funds illicitly obtained from the Medicare program through a fraudulent scheme.
A considerable number of Medicare fraud cases commence because of allegations put forward by whistleblowers. Although there are many situations in which a whistleblower is acting in good faith, that is not always the case.
With alarming frequency, disgruntled employees, competitors, and others with an axe to grind submit false reports regarding allegations of Medicare fraud. If this describes your situation, your immediate reaction may be to brush the allegation off. You may assume that because it is false, the allegation being made will go nowhere.
You simply cannot take this type of an approach to an allegation of Medicare fraud, even if you think that it is groundless. You must mount a defense, even to a groundless allegation. Standing silent or ignoring the process places you in legal jeopardy, even in the case of an unwarranted, untrue allegation of Medicare fraud.
Ancillary Legal Issues
A Medicare fraud charge can lead to ancillary legal problems as well. When seeking legal representation, you will want to keep an eye open for an attorney with experiencing in addressing these issues as well.
A prime example of an ancillary legal issue is the prospect of a disciplinary action taken against a doctor, in addition to any action being taken by the federal government in regard to a Medicare fraud allegation. Texas professional licensing authorities take a very dim view of physicians and others who engage in Medicare fraud.
A doctor involved in a Medicare fraud investigation also faces the prospect of having his or her privileges at hospitals revoked. Obviously, this represents another type of negative action you want to protect against if at all possible.
Attorney Representation During Investigation
A wise decision to make is to engage a defense attorney as soon as you get wind of a Medicare fraud investigation. In most cases, the target of a Medicare fraud investigation is aware that it is occurring.
A more ideal resolution of a Medicare fraud case is reaching some sort of negotiated settlement of it prior to the filing of actual charges. There are civil remedies available in the Medicare fraud laws that may be invoked short of a full-blown criminal prosecution.
Retain Houston Medicare Fraud Attorneys
The best course you can take when facing the prospect of a Medicare fraud investigation or prosecution is to retain Houston Medicare fraud attorneys promptly. You definitely want to select a Houston Medicare fraud attorney that has specific experience with your type of case.
The first step in retaining defense counsel is to schedule an initial consultation. During an initial consultation, legal counsel will provide an analysis of your case, including a presentation of possible defense strategies. In addition, a Medicare fraud lawyer will answer your questions.