Medicare & Medicaid Fraud

medicare and medicaid fraud

Medicare and Medicaid fraud is a form of health care fraud regarding those specific providers. In general terms, health care fraud is an illegal scheme involving either private or public health insurance providers. While a typical example of health care fraud is an individual defrauding the system to get health coverage, consumers are not the only ones who can face healthcare fraud charges. Insurance companies, doctors, health care agencies, nursing homes, hospitals, and contract carriers for Medicare and Medicaid can also face criminal prosecution for health care fraud. No matter if you are an individual or an agency facing fraud charges, you’ll require the representation of a knowledgeable defense attorney.

The Orlando Medicare & Medicaid fraud defense attorneys at The Umansky Law Firm are skilled criminal defense attorneys with over 100 years of combined experience. With time spent as prosecutors on the state and local level, we understand the tactics used to get a conviction. Healthcare fraud is a federal offense and will require the services of an attorney with experience handling federal cases. Our Board Certified Criminal Trial Lawyers have a wealth of experience representing individuals facing federal charges that he can implement to the benefit of your case. Reach out to us today so that we can start constructing a defense on your behalf.

Examples of Medicare & Medicaid Fraud

As mentioned earlier, both private citizens and corporations can face health care fraud charges. In either instance, there are specific actions and patterns that law enforcement will look out for to determine whether or not health care fraud is occurring. Some of the more common fraudulent activity that companies take part in include:

  • Charging for services not performed
  • Altering medical records
  • Unbundling billed services
  • Editing services, dates, and names of patients on claims
  • Overbilling for services
  • Referral kickbacks or self-referrals
  • Providing unnecessary services
  • Submitting duplicate claims
  • Misdiagnosing to increase payments

This type of activity is known to go on for months or even years before authorities catch on. However, health care professionals are not the only one under scrutiny for fraud. Individual health care plan members are often monitored for suspicious activity including:

  • Filing false claims
  • Forging prescriptions
  • Claiming treatment that never occurred (home health care, alcohol dependency classes, therapy appointments, etc.)
  • Filing claims under a false name
  • Claiming nonexistent injuries or illnesses

The federal government takes these infringements seriously and will attempt to hold you accountable for all offenses they believe you committed.

Penalties for Medicare & Medicaid Fraud

As a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), health care fraud is a federal offense. The penalties associated with a criminal conviction for health care fraud depends on whether you are an individual or corporation and also the acts violated during the commission of the crime.

Federal health care fraud in violation of HIPAA is punishable by up to 10 years in prison per offense. Making a false claim or statement on a Medicare or Medicaid claim in violation of the False Claims Act can result in up to 5 years in prison and up to a $250,000 fine per offense. Organizations that make false claims face up to $500,00 in fines per offense. If the false claim results in serious bodily injury, the potential sentence increases to 20 years. Organizations face up to life in prison if the health care fraud results in death.

Defending Against Medicare & Medicaid Fraud Charges

For the federal government to get a conviction for health care fraud, they must be able to prove beyond a reasonable doubt that you had the intentions of defrauding the system. One cannot be legally convicted of health care fraud for making an honest mistake.

The federal government, however, is relentless in their pursuit of a conviction and will often use private informants or speak to previous employers to gather evidence. It is not uncommon for negligence and simple paperwork errors to be viewed as fraud. Medicare and Medicaid billing procedures are also highly complicated, and a simple coding error can raise a red flag.

As the money continues to pour in in support of ridding the system of fraud, more and more health care professionals and individuals will face fraud. It is then your responsibility to seek out services of criminal defense attorneys who can best position you for a favorable ruling.

Orlando Medicare & Medicaid Fraud Defense Attorneys

The team of Orlando Medicare and Medicaid fraud defense attorneys at The Umansky Law Firm will vigorously combat the efforts of the opposition to get a conviction. We can investigate the matter further through conducting interviews with employees, sifting through records, and speaking with the other targets of the investigation to help free you of all charges.

We can also help ensure that you protect your best interest by advising you on how to conduct yourself throughout the investigation. Contact us today for a free case evaluation at 407-228-3838 and learn how our Board Certified Criminal Trial Lawyers can help you.