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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.