Cases of government insurance fraud in the healthcare sector are wildly common, and authorities have grown more vigilant over the years. Even the smallest misstep can land you or your organization in jeopardy. Medicare fraud is one of the challenges that healthcare professionals have to consider when going about their duties.
Fraud cases involving Medicare fall under the False Claims Act violation. The False Claims Act provides protection for the government and its agencies when implementing its spending programs. The implications of a medical practitioner or institution getting accused of Medicare fraud can be damaging. However, you can mitigate the aftermath by working with an attorney with Medicare fraud experience.
Medicare Fraud Scenarios
Understanding what constitutes fraud puts you at an advantage because you can analyze your circumstances objectively. Some of the common forms of Medicare fraud include:
• Billing a patient for services not provided
• Offering a Medicare package that has not undergone government approval
• Billing equipment to Medicare when an institution did not receive them
• Misleading customers into joining a Medicare Plan
• Paying kickbacks to induce medical device or medication purchases
• Billing clients for faulty medical equipment
• Failing to report true best price of drugs for the purpose of reducing government rebates
• Filing bogus prescriptions
• Billing for unnecessary test kits and unused medical devices
• Writing fraudulent scripts
All these are instances that may get you in legal complications that are too massive to recover from.
Note that Medicare fraud extends to other government healthcare programs as well. False claims in federal worker’s compensation, Medicaid, and Tricare also fall into the same category of offenses. Violation of statutes such as Physician Self-Referral Law, Anti-kickback Statute, U.S Criminal Code, and Social Security Act can result in charges of Medicare fraud.
Some regions in the U.S face high scrutiny when it comes to Medicare fraud. San Diego is one of those regions and the main reason for increased risks of prosecution is a large number of beneficiaries. The Medicare Fraud Strike Force is one agency responsible for catching perpetrators of government insurance fraud.
Consequences of Medicare Fraud
The mere fact of being under investigation for fraud will have a domino effect in your life. If an accusation is against an individual, then it may destroy his/her life and the family as well. An individual’s career is not spared when it comes to such accusations. Recovering from such a scandal may take a long time, especially if there is a conviction. A criminal record can hinder you from progressing with your career, which is why a lawyer is useful to have at your disposal. Medicare fraud is a federal crime, and that means severe penalties. An accused person can get a sentence of up to ten years for each count. In the event of a dead patient due to Medicare fraud, the sentence could be life. There is also the threat of a medical professional losing their license.
An organization accused of Medicare can incur colossal fines, depending on the magnitude of the fraud. A company may also be excluded from future healthcare programs, which can be devastating for business. It is hard for suppliers, clients or patients to trust an institution under investigation for fraud. Besides civil penalties, criminal charges may also fall on certain individuals directly involved in the fraud.
Get a Lawyer
With all the work that healthcare practitioners encounter and the complexities of some of their duties, it is easy to make mistakes when delivering services. You may commit Medicare fraud without even realizing it. For instance, a hospital administrator may make a mistake when calculating the cost of services provided to a patient. An attorney can provide the proper defense in such instances to reduce the degree of punishment a judge gives out. Lawyers in San Diego can develop strategic approaches to your case to ensure the outcomes don’t leave you scarred permanently.
Medicare fraud cases take different forms and may involve violations of several statutes. You require counsel that explains the implication of each violation and the possible repercussions. Grasping the gravity of your situation will help you prepare appropriately. An attorney is also useful when it comes to negotiations. A skillful negotiator can help bring down your charges or work out a deal that will not see you lose everything.
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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.
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.
Medicare fraud is one of the most serious types of white collar crimes prosecuted by the federal government. If you find yourself in the midst of an investigation based on an allegation of Medicare fraud, or if charges already have been lodged against you, you are in a significantly serious situation.
Finding yourself involved in a Medicare fraud case, it is crucial that you understand some of the basic facts associated with this type of crime. In addition, you must take a proactive stance to protect fully your legal rights and interests. This includes moving promptly to engage the services of experienced Philadelphia Medicare fraud lawyers.
Understanding What Constitutes Medicare Fraud
Medicare fraud can take a number of different forms. One of the most common types of Medicare fraud is up-coding. In simple terms, what this is that a healthcare provider improperly codes patient procedures rendered in a bill to Medicare. The healthcare provide codes in a more expensive procedure of treatment than what actually was provided to a patient.
Another type of Medicare fraud is called phantom billing. This illicit practice gets its name from cases in which bills are submitted to Medicare for patients that did not actually receive any services.
A related scheme involves prescribing expensive and unnecessary procedures for patients. This results in heftier bills being sent to Medicare for these unnecessary treatments or procedures.
In some cases, a patient becomes involved in a Medicare fraud scheme. In this situation, a patient is brought into the scheme and the healthcare provider pays what can best be described as a kickback to the patient.
Penalties Upon Conviction for Medicare Fraud
The potential penalties upon conviction for Medicare fraud can be significant. The Federal Sentencing Guidelines provide parameters a judge can consider when imposing a sentence in a Medicare fraud case.
Three significant factors come into play when a determination is made regarding a sentence in a Philadelphia Medicare fraud case. First, the amount of money involved in the scheme is a prime consideration under the U.S. Federal Sentencing Guidelines. Simply, the more money involved in the scheme, the longer the possible prison sentence and the higher the possible fine.
Second, a defendant’s criminal history is another factor considered during the sentencing phase of a Medicare fraud case. A lack of a criminal record works to at least somewhat contain the length of imprisonment and the amount of a fine in a Medicare fraud case.
Finally, the Sentencing Guidelines give a person what can be described as credit for “cooperating” in the case. What this usually means is that the defendant enters into a plea agreement fairly early on in the case.
With that noted, a person charged with Medicare fraud should never attempt to negotiate a plea agreement on his or her own and without legal representation. A healthcare provider could seriously, unknowingly jeopardize his or her rights and interests by trying to take a resolution of these serious criminal charges into his or her own hands.
Philadelphia Medicare fraud lawyers can also assist you with ancillary problems that likely are to rise in the aftermath of this type of criminal charge. A physician faces the loss of his or her medical license. In addition, he or she will face a revocation of hospital privileges.
Depending on the scope of the alleged Medicare fraud, the possibility can exist to contain some of these ancillary issues. This objective further underscores the need to be proactive in retaining Philadelphia Medicare fraud lawyers.
Retain Philadelphia Medicare Fraud Lawyers
Philadelphia Medicare fraud lawyers are available to consult with you about your case. Keep in mind that the general practice for Philadelphia Medicare fraud lawyers is to charge no fee for an initial consultation.
During the course of an initial consultation, an Medicare fraud defense attorney will provide you with evaluation of your case. This includes a discussion of possible defense strategies that may be available to you.
In addition to providing a comprehensive overview of possible defenses in your situation, a Medicare fraud defense lawyer will also respond to any questions that you may have about your case. For this reason, you need to come to the meeting fully prepared with the key questions for which you desire answers from legal counsel.
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