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Medicare Fraud + Laws, Charges & Statute of Limitations

White-collar crime is a nonviolent, financially motivated crime committed by someone working for the government or a business. An example of white-collar crime is health care fraud. Healthcare fraud occurs when there is an intentional submission of false information to receive greater financial benefits.

Healthcare is one of the largest industries. The United States spends approximately $2 trillion each year on healthcare. Unfortunately, the United States also spends almost $68 billion each year on healthcare fraud.

Types of Healthcare Fraud

Due to the large industry of healthcare, fraudulent activity has been rampant over the last two decades. As a result, the government has put into action task forces to diligently monitor and handle healthcare fraud. The majority of healthcare fraud occurs with Medicaid and Medicare.

There are many ways in which a business or government professional can perform healthcare fraud. A top culprit is overbilling or billing for services that are non-existent. Another common fraudulent activity is increasing the cost of a medical procedure by billing for each step of the procedure.

Mis-diagnosing or the false diagnosis of a patient in order to receive financial gain is healthcare fraud. When a physician’s office or hospital does not accurately classify a procedure with the purpose of being compensated, they are guilty of healthcare fraud.

Billing more for a service than what it is worth is called upcoding. Upcoding allows the organization to bill for more money and this is considered healthcare fraud. Kickbacks and incentives for patient referrals or tampering with deductibles and copays are all criminal activities.

Medicare Fraud Laws

Christine Twomey
Christine Twomey
2024-03-21
Just had my Divorce case settled 2 months ago after having a horrible experience with another firm. I couldn’t be happier with Claire Banks and Elizabeth Garvey with their outstanding professionalism in doing so with Spodek Law Group. Any time I needed questions answered they were always prompt in doing so with all my uncertainties after 30 yrs of marriage.I feel from the bottom of my heart you will NOT be disappointed with either one. Thanks a million.
Brendan huisman
Brendan huisman
2024-03-18
Alex Zhik contacted me almost immediately when I reached out to Spodek for a consultation and was able to effectively communicate the path forward/consequences of my legal issue. I immediately agreed to hire Alex for his services and did not regret my choice. He was able to cover my case in court (with 1 day notice) and not only was he able to push my case down, he carefully negotiated a dismissal of the charge altogether. I highly recommend Spodek, and more specifically, Alex Zhik for all of your legal issues. Thanks guys!
Guerline Menard
Guerline Menard
2024-03-18
Thanks again Spodek law firm, particularly Esq Claire Banks who stood right there with us up to the finish line. Attached photos taken right outside of the court building and the smile on our faces represented victory, a breath of fresh air and satisfaction. We are very happy that this is over and we can move on with our lives. Thanks Spodek law 🙏🏼🙏🏼🙏🏼🙏🏼🙌🏼❤️
Keisha Parris
Keisha Parris
2024-03-15
Believe every single review here about Alex Z!! From our initial consultation, it was evident that Alex possessed a profound understanding of criminal law and a fierce dedication to his clients rights. Throughout the entirety of my case, Alex exhibited unparalleled professionalism and unwavering commitment. What sets Alex apart is not only his legal expertise but also his genuine compassion for his clients. He took the time to thoroughly explain my case, alleviating any concerns I had along the way. His exact words were “I’m not worried about it”. His unwavering support and guidance were invaluable throughout the entire process. I am immensely grateful for Alex's exceptional legal representation and wholeheartedly recommend his services to anyone in need of a skilled criminal defense attorney. Alex Z is not just a lawyer; he is a beacon of hope for those navigating the complexities of the legal system. If you find yourself in need of a dedicated and competent legal advocate, look no further than Alex Z.
Taïko Beauty
Taïko Beauty
2024-03-15
I don’t know where to start, I can write a novel about this firm, but one thing I will say is that having my best interest was their main priority since the beginning of my case which was back in Winter 2019. Miss Claire Banks, one of the best Attorneys in the firm represented me very well and was very professional, respectful, and truthful. Not once did she leave me in the dark, in fact she presented all options and routes that could possibly be considered for my case and she reinsured me that no matter what I decided to do, her and the team will have my back and that’s exactly what happened. Not only will I be liberated from this case, also, I will enjoy my freedom and continue to be a mother to my first born son and will have no restrictions with accomplishing my goals in life. Now that’s what I call victory!! I thank the Lord, My mother, Claire, and the Spodek team for standing by me and fighting with me. Words can’t describe how grateful I am to have the opportunity to work with this team. I’m very satisfied, very pleased with their performance, their hard work, and their diligence. Thank you team!
Anthony Williams
Anthony Williams
2024-03-12
Hey, how you guys doing? Good afternoon my name is Anthony Williams I just want to give a great shout out to the team of. Spodek law group. It is such a honor to use them and to use their assistance through this whole case from start to finish. They did everything that they said they was gonna do and if it ever comes down to it, if I ever have to use them again, hands-down they will be the first law office at the top of my list, thank you guys so much. It was a pleasure having you guys by my side so if you guys ever need them, do not hesitate to pick up the phone and give them a call.
Loveth Okpedo
Loveth Okpedo
2024-03-12
Very professional, very transparent, over all a great experience
Bee L
Bee L
2024-02-28
Amazing experience with Spodek! Very professional lawyers who take your case seriously. They treated me with respect, were always available, and answered any and all questions. They were able to help me very successfully and removed a huge stress. Highly recommend.
divesh patel
divesh patel
2024-02-24
I can't recommend Alex Zhik and Spodek Law Firm highly enough for their exceptional legal representation and personal mentorship. From the moment I engaged their services in October 2022, Alex took the time to understand my case thoroughly and provided guidance every step of the way. Alex's dedication to my case went above and beyond my expectations. His expertise, attention to detail, and commitment to achieving the best possible outcome were evident throughout the entire process. He took the time to mentor me, ensuring I understood the legal complexities involved to make informed decisions. Alex is the kind of guy you would want to have a beer with and has made a meaningful impact on me. I also want to acknowledge Todd Spodek, the leader of the firm, who played a crucial role in my case. His leadership and support bolstered the efforts of Alex, and his involvement highlighted the firm's commitment to excellence. Thanks to Alex Zhik and Todd Spodek, I achieved the outcome I desired, and I am incredibly grateful for their professionalism, expertise, and genuine care. If you're in need of legal representation, look no further than this outstanding team.

The government is making it harder for people to participate in healthcare fraud. Laws and policies are set in place to limit healthcare fraud and misconduct. The following federal laws monitor healthcare fraud:

• Anti-Kickback Statute – This law prohibits a person from receiving any type of incentive, payment, or reward for referring patients.
• False Claims Act – This act prohibits submitting false insurance or healthcare claims to the United States government.
• Stark Law – The Physician Self-Referral Act prohibits physicians from referring patients to doctors and facilities in which there is a vested financial interest.
• Exclusion Statute – With this act, doctors that have a history or have been convicted of criminal crimes cannot participate in Medicare.
• Civil Monetary Penalty Law – The law states that monetary penalties and Medicare exclusion can take place for any type of government fraudulent behavior.

The laws above are all governed by the Office of Inspector General, the Department of Health and Human Services, and the U.S. Department of Justice. These are the laws that govern Medicare fraud in the United States.

Medicare Fraud Punishment

A Medicare fraud punishment or sentence is influenced by the amount of money that was falsely claimed. The maximum sentence for healthcare fraud is 10 years.

Although this is the maximum sentence in most states it can be increased if bodily injury occurs as a result of fraudulent activity. In this case, a person can face up to 20 years of prison time. If death occurs as a result of Medicare fraud, a person can face life in prison.

There are different categories of punishment and violation dealing with Medicare fraud. Violations under the False Claims Act may result in a $250,000 fine and 5 years of prison time. If the Anti-Kickback Statute is violated, you can expect 5 years of prison time and a $25,000 fine.

Punishment does not stop with fines and jail time. Medicare fraud can result in a physician losing their license or not being able to participate in healthcare programs funded by the federal government.

Medicare Fraud Defense

In some cases, a healthcare provider can be improperly charged with Medicare fraud. Honest billing mistakes or not reporting accurately can cause a red flag for Medicare Fraud.

A full investigation is required if Medicare fraud is expected. Attorneys are able to help navigate the process of making sure the Medicare fraud is accurate or if it was an honest mistake.

A Medicare fraud case can include multiple people. An investigation is required to determine who is at fault and the extent of the damages. The U.S. government has put many teams in place to protect patients and to limit Medicare fraud.

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