Unraveling the Complexities of Medicare Fraud: A Deep Dive

What is Medicare Fraud?

Medicare fraud, a serious federal white-collar crime, involves the deliberate deception of Medicare to obtain financial gain. It’s a complex issue with far-reaching consequences, affecting both individual beneficiaries and the entire healthcare system. Here at Goldstein & Orr, we have decades of experience successfully representing clients charged with medicare fraud. 

The Legal Landscape of Medicare Fraud

A number of federal laws govern Medicare fraud. Key statutes include:

• The False Claims Act: This powerful law, [31 U.S.C. § § 3729-3733] ,  prohibits knowingly submitting false claims to the government, including Medicare. It allows for both civil and criminal penalties, including treble damages and significant fines.
• The Anti-Kickback Statute: This law, [42 U.S.C. § 1320a-7b(b)] prohibits the payment of remuneration to induce referrals for services or goods reimbursable by federal health care programs, such as Medicare. It aims to prevent healthcare providers from referring patients to other providers in exchange for kickbacks or bribes.
• The Stark Law: This law, also referred to as the Physician Self-Referral Law [42 U.S.C. § 1395nn], prohibits physicians from referring Medicare patients for designated health services to entities with which the physician has a financial relationship, unless an exception applies. It aims to prevent conflicts of interest that could lead to overutilization of healthcare services.

Common Tactics Employed by Individuals Accused of Medicare Fraud

Fraudsters use a variety of tactics to defraud Medicare. Some of the most common include:

• Billing for Services Not Rendered: Submitting claims for services that were never provided, such as phantom treatments or unnecessary tests.
• Upcoding: Billing for a more expensive service than the one actually provided, inflating the reimbursement amount.
• Billing for Unnecessary Services: Submitting claims for services that were not medically necessary, such as excessive or unnecessary tests or procedures.
• Patient Bribery: Offering patients money or other incentives to enroll in Medicare or to receive unnecessary services.
• Identity Theft: Using the identity of a deceased or living person to obtain Medicare benefits.
• Phantom Providers: Billing for services provided by providers who do not exist or are not qualified to provide those services.
• Ringing: Billing for multiple services at the same time, even if they were not provided simultaneously.

The Devastating Impact of Medicare Fraud

Medicare fraud not only drains billions of dollars from the Medicare program but also undermines the integrity of the healthcare system. It can lead to higher healthcare costs, reduced access to care for legitimate beneficiaries, and compromised patient safety. According to the organization Senior Medicare Protection, medicare faces significant financial losses annually due to fraud, errors, and abuse. While estimates vary, it’s widely acknowledged that these losses can exceed $60 billion per year, making the precise figure difficult to quantify. This impact is the reason why the Federal Government and United States Attorney’s Offices take these allegations very seriously and seek harsh penalties for those accused of the offense. 

Hiring a Federal White-Collar Criminal Defense Lawyer

At Goldstein & Orr, we are dedicated to combating Medicare fraud charges and protecting the rights of all of our clients. Our experienced attorneys have a deep understanding of the complex legal issues involved in Medicare fraud cases. We have a proven track record of success in representing clients accused of Medicare fraud.

If you are facing allegations of Medicare fraud or believe you have been a victim of fraud, please contact a white-collar criminal defense attorney in our office to schedule a consultation. We will work tirelessly to protect your rights and achieve the best possible outcome.