What Is Medicare Fraud?
Medicare is the United States' federal health insurance program for the elderly and disabled. Its purpose is to provide needed health care to that segment of the American population who otherwise have no health insurance. Medicare fraud involves the crime of knowingly billing the Medicare program for unnecessary or non-existent services, or billing for services that were not rendered.
Medicare fraud can also include submitting claims for services that were never provided, or for patients who never received such services. Medicare fraud can be committed through a variety of methods, including the following:
Falsification of medical or billing records
Billing for services that were not provided, or not provided in the manner claimed
Billing for unneeded services
If you or a loved one has been charged with Medicare fraud, you need the help of an experienced criminal defense attorney. The government will often aggressively pursue charges in this area, and will not hesitate to pursue the harshest penalties and fines.
Why Would Someone Commit Medicare Fraud?
Medicare fraud is a very serious crime, because it involves stealing money from the government. Medicare fraud is also a serious crime because it is an attack on the intended beneficiaries of the program: the elderly and disabled.
Many individuals who commit Medicare fraud are doctors who have close relationships with their patients, and believe that they are helping the patient regain his or her health. Often this is done by prescribing unnecessary or inappropriate medications.
However, the doctor may be receiving kickbacks from the pharmaceutical companies, who may be paying him to prescribe their medications. These kickbacks are illegal, and patients can also be charged with Medicare fraud if they knowingly fill prescriptions from doctors who are engaging in illegal activity.
Other individuals may be looking to make a quick profit. Some will actually be working for a group of people who are planning a Medicare fraud scheme. In some cases, these Medicare fraud rings will have doctors and other medical staff working for them, and they will be able to pad their bills with unnecessary services.
In other cases, Medicare fraud rings will use kickbacks to convince doctors to prescribe unnecessary medications. Medicare fraud rings can also use kickbacks to convince pharmacists to fill prescriptions for unnecessary medications.
In still other cases, fraud rings will convince senior citizens to admit themselves to medical facilities and then fill out false Medicare claims. These are called “patient brokers.” In some cases, the senior citizen may actually be aware of the Medicare fraud and may have been paid by the Medicare fraud ring to participate in the fraud.
In the worst cases, Medicare fraud rings may actually have members who are doctors or medical staff, and are deliberately harming their patients in order to maximize their Medicare billing. This is called “doctor shopping.”
What are the Consequences of Medicare Fraud?
Medicare fraud is a serious crime, because it involves stealing money from the government. It is also a serious crime, because it involves stealing from the elderly and disabled Americans who depend on the Medicare program for their health care.
In addition, individuals who engage in Medicare fraud may also be charged with other crimes, such as the following:
Health care fraud
Health care kickback violations
The penalties for health care fraud can be very severe. If the fraud is committed by a doctor, lawyer, or a medical professional, the maximum penalty for health care fraud is ten years in prison and $250,000 in fines. If the fraud is committed by a non-medical professional, the maximum penalty is five years in prison and $250,000 in fines.
In some cases, individuals who commit health care fraud may be charged with health care kickback violations. These are charged in addition to fraud charges because they provide monetary incentives for health care providers to commit fraud.
It is illegal for individuals to offer a kickback in return for Medicare referrals. Medicare fraud can also involve hospice fraud, which involves fraud against the hospice care program.
In some cases, Medicare and Medicaid fraud may also involve a Medicare or Medicaid beneficiary receiving kickbacks or bribes. For example, a patient who is receiving Medicare care may be offered a kickback for signing up for an unnecessary service.
Another example would be a patient being paid to fill out a fake Medicare claim form. In some cases, the kickback may involve cash. However, some Medicare fraud rings may be willing to pay in other ways, such as gifts or even prescription medications.
Not only are the kickbacks illegal, but they may also encourage patients to engage in behavior that is dangerous to their health. In some cases, the kickback may involve a doctor or medical professional sending a patient to a medical facility or pharmacy where he receives medications that are not needed.
The doctor may receive kickbacks for sending the patient to the facility or pharmacy. These kickbacks can be illegal and may result in Medicare fraud charges.
In other cases, kickbacks may involve encouraging a patient to undergo unnecessary surgery. Some Medicare fraud rings may also involve kickbacks to doctors who refer patients to a medical facility or a pharmacy.
These kickbacks are illegal and may involve bribery, and may also encourage the doctor to refer patients to a medical facility or pharmacy where the kickbacks are received.
Another crime that may be involved in Medicare fraud is money laundering. This involves concealing the source of income from illegal activities. Medicare fraud rings may also involve money laundering, which may involve trying to cover up payments to seniors.
For example, a Medicare fraud ring might give a senior citizen a check in the amount of $1000 and instruct the senior citizen to come up with a reason for receiving the check. The senior citizen might then claim that the $1000 is in payment for a medical procedure that he did not actually need. This is known as a “straw purchaser” or a “front person.”