Medicare is a government insurance program that many elderly individuals have so that they can pay for prescriptions, visits to the doctor and even visits to the hospital where the person has to stay overnight. There are some doctors who will commit medicare fraud as well as healthcare agencies, such as hospitals or nursing homes. Sometimes, the fraud goes undetected because it’s done in a manner that isn’t seen as clearly as abuse. The person who commits the fraud often covers any issues with paperwork that is completed, or the patient doesn’t know what’s going on because the doctor doesn’t let the patient know. The patient believes that any medicare charges are legitimate because they are received by the doctor or facility.
In most situations, the doctor or facility will overcharge for the services that are provided. This means that medicare will pay more to the billing party without knowing whether the services were really provided or not. This is when patients and caretakers can start to examine the medicare paperwork that is received. If the patient sees something that hasn’t been done, then the medicare office can be alerted.
Another way of committing fraud is with prescriptions. The doctor would write prescriptions that are worth more money than what the patient needs, and when medicare approves the bill, then the doctor or pharmacist would keep the extra money while dispensing a drug that doesn’t match what was prescribed. This is common with those who are addicted to certain medications, like pain killers. A payment f a kickback is sometimes given to a doctor or pharmacy in order to promote a new drug or to use a certain kind of drug or treatment option. If more people use that item, then the doctor or pharmacy will get a percentage of what is made or a certain amount of money.
Defective test kits sometimes come into a doctor’s office or facility. The right thing to do would be to send the kit back to the manufacturer to get another one. However, many people will bill medicare for the price of the original item, get the money and then bill for another item that is the same thing. The older product would be given to the patient or used in an office or facility while the new item that is received would be given to another patient or kept for personal use.
Rebates are often given when it comes to government programs, such as medicare. Doctors often know about these rebates but do nothing in order to reduce costs associated with them. Up-coding is another way to commit medicare fraud. This is when multiple codes are used when sending in the billing paperwork instead of combining the codes, which would be less expensive for medicare to pay. This is why many medicare premiums are so expensive, along with the increased price of medications because doctors and pharmacies tend to inflate the true costs of drugs. There are some people who will provide services without being licensed. They will bill medicare in order to get money and make patients think that they are professionals when they are simply trying to scam the government. Billing for add-on services that the patient doesn’t need is another way to commit medicare fraud.
If you have been accused of medicare fraud in Austin, it’s best to seek the help of an attorney. You risk losing any license that you have as well as spending time in prison as this is often a federal and state offense. An attorney can help get your sentence reduced in some cases or explain the timeline of events that might occur so that you have support through the process.