Medicare & Medicaid Fraud
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What are Medicare & Medicaid?
Medicare is a federal program attached to Social Security and is available to all U.S. citizens 65 years of age or older, as well as people with certain disabilities. It is available regardless of income.
Medicaid is a public assistance program based largely on financial need, and is a joint federal and state program that helps low-income individuals and families pay for the costs associated with medical and long-term custodial care. Unlike Medicare, a program largely standardized by the federal government, state and local governments administer Medicaid using federal guidelines. Each state can shape the program to its individual needs. Because of this federal/state partnership, there are actually 50 different Medicaid programs, one for each state.
What is Medicare fraud?
When medical professionals have patients who pay for their services through Medicare or Medicaid, those medical professionals have to bill the government so that they can receive their money. If these medical professionals bill the government too many times or make a mistake in the process, they risk being charged with Medicare or Medicaid fraud.
What are examples of Medicare fraud?
There are many instances and situations that can lead to an individual being charged with Medicare or Medicaid fraud, among them:
- Billing for services not rendered
- Billing for the same treatment multiple times
- Billing for non-existing patients
- Misrepresenting dates of service
- Misrepresenting locations of service
- Misrepresenting provider of service
- Billing for a non-covered service as a covered service
- Incorrect reporting of diagnoses or procedures (includes unbundling)
- Overbilling
- Overutilization of services
- Corruption (kickbacks and bribery)
- False or unnecessary issuance of prescription drugs
- Waiving of deductibles and/or co-payments
Whatever the case, if you have been charged with Medicare or Medicaid fraud, you need a crimnal defense attorney on your team who knows how to handle these cases. Medicare fraud cases are usually very complex, they may carry very stiff penalties, and require a specific set of skills and knowledge to be handled properly. At NeJame Law, our Orlando Medicare and Medicaid fraud lawyers have years of experience litigating in federal court. You do not need to look any further—help is here.
Have you been accused of Medicare or Medicaid fraud in Florida? Call us for accessible and trusted defense services at (407) 500-0000. Our Orlando Medicare and Medicaid fraud lawyers are well-versed in federal and state laws and will work hard to get you the best outcome on your case.
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Frequently Asked Questions
What are the penalties for Medicaid/Medicare fraud?
The penalties for Medicare/Medicaid fraud can be severe, especially if they involve multiple offenses. This often means that fraud can be charged at both state and federal levels. These penalties include fines ,civil lawsuits, medical sanctions, imprisonment, multiple counts, and racketeering/RICO prosecutions.
Who investigates Medicaid fraud?
The Florida Attorney General’s Medicaid Fraud Control Unit (MFCU) investigates and prosecutes fraud involving providers that intentionally defraud the state's Medicaid program through fraudulent billing practices. The MFCU investigates a wide range of misconduct originating primarily from fraudulent billing schemes. The most common schemes involve doctors, dentists, clinics, and other health care providers billing for services never performed, overbilling for services provided, or billing for tests, services, and products that are medically unnecessary.
Who investigates Medicare fraud?
The Office of Inspector General for the U.S. Department of Health and Human Services is tasked with protecting the integrity of Department of Health and Human Services (HHS) programs, including Medicare and Medicaid programs, as well as the health and welfare of the beneficiaries of those programs. The Office of Investigations for the HHS, OIG collaboratively works with the Federal Bureau of Investigation in investigating Medicare Fraud.