What Is the Most Common Form of Medicare Abuse? 2024

Medicare and other healthcare programs can be admittedly complex. Sometimes, an error may appear to be a simple misunderstanding. However, in other circumstances, it’s an actual instance of Medicare abuse. Medicare fraud presumes criminal intent behind the misconduct. This leads many concerned citizens to ask, “What is the most common form of Medicare abuse?”

If you’ve been accused of facilitating or being involved in any form of healthcare fraud, you should promptly speak with a federal crime defense attorney to protect yourself. The legal professionals at The Law Offices of Richard Kuniansky are qualified to represent clients facing charges of Medicare fraud, healthcare fraud, federal medical or financial fraud, and other serious offenses.

What Is Considered Medicare Abuse in Texas?

Medicare abuse is a type of healthcare fraud that entails billing beneficiaries of a Medicare or Medicaid plan who aren’t covered by such programs. Sometimes, these instances are mistakes but when there’s reason to suspect fraud, such as a pattern of misconduct, criminal intent on the part of the provider is assumed.

Common Forms of Medicare Fraud or Abuse

Fraud is any act that involves purposely and knowingly deceiving or misrepresenting a situation for the gain of the offenders. Medicare or Medicaid fraud that’s committed by a provider with the intention to personally profit from such acts can be considered healthcare abuse. These are some examples of the most common forms of healthcare fraud and abuse:

• Routinely waiving co-insurance or deductibles as an incentive to increase business
• Purposefully misrepresenting a medical diagnosis, a beneficiary’s identity, the services or treatment provided, and other facts to justify costs
• Providing or prescribing medical services and tests excessively or unnecessarily, given the situation
• Billing for services, treatment, or supplies that were not provided
• Providing beneficiaries with unsolicited supplies
• Refusing to bill Medicare for covered items or services and, instead, billing a beneficiary, which is a violation of the agreement between a participating provider and Medicare
• Requesting Medicare numbers during an unsolicited phone call, educational presentation, or other inappropriate communication
• Receiving or offering a kickback (bribe) in exchange for a patient’s Medicare number

Criminal Punishment After a Medicare Fraud Conviction

Medicare is more vulnerable to fraud and abuse than any other type of healthcare program. For this reason, Medicare fraud has been increasingly investigated, prosecuted, and penalized in recent years—with the Department of Justice aggressively leading coordinated efforts with various agencies to crack down on healthcare abuse. These groups include the Office of the Inspector General, the FBI, and the Centers for Medicare and Medicaid Services.

It’s important to retain legal representation who has experience in federal proceedings as well as Medicare fraud charges in particular. If convicted of Medicare or Medicaid fraud, a defendant is subject to:

• Incarceration in prison or possible probation in some cases
• Fines
• Mandatory restitution to the government or affected victims
• Future exclusion from Medicare and other government healthcare programs

In addition to the criminal penalties, those convicted of healthcare fraud may be debarred from working at any facility that bills Medicare, even if they have no involvement with billing procedures. Guilty defendants may also lose their professional licenses altogether. Furthermore, they face difficulty finding an education, career opportunities, and reasonable housing, among other adverse impacts.

FAQs

What Does a Medicare or Healthcare Fraud Defense Lawyer Do?

The role of your Medicare fraud defense lawyer is to:

• Protect you from incriminating yourself.
• Assert your Constitutional rights.
• Thoroughly investigate the criminal allegations against you.
• Prepare a strong and compelling defense on your behalf.
• Anticipate what arguments and evidence the prosecution is likely to use in their case.

Having a qualified and skilled defense attorney to guide you through the legal process and proceedings is an invaluable resource to have on your side.

Who Investigates Cases of Medicare or Medicaid Fraud?

Several groups may investigate an occurrence of Medicare or Medicaid fraud. The Department of Justice takes crimes of healthcare abuse very seriously, so it often recruits various agencies to look into suspected fraud against the government.

Each state has its own Medicaid Fraud Control Unit that works with the Attorney General’s office. Additionally, agencies such as the FBI and the Office of Inspector General under the Federal Trade Commission may also investigate cases of government healthcare fraud.

How Do You Fight Against Charges of Medicare Fraud?

Depending on the nature of the Medicare fraud charges against you, your criminal defense attorney may employ various defense strategies when building your case. To convict you of Medicare or Medicaid abuse, the prosecution must sufficiently prove all the elements of healthcare fraud, such as the defendant committing the fraudulent act with the intention of defrauding the government. Your lawyer can help you collect evidence that you weren’t trying to defraud or benefit from the misconduct.

What Are the Most Common Examples of Medicare Fraud?

Some common forms of Medicare fraud include:

• Unnecessarily or excessively ordering or administering medical tests and services
• Routinely waiving deductibles or co-insurance
• Billing for treatment or supplies that were not provided
• Billing a beneficiary instead of Medicare for items or services covered by the program
• Misrepresenting a beneficiary’s identity, medical diagnosis, received treatment, or other facts to justify payment

What Are the Repercussions of Medicare or Medicaid Fraud?

The legal repercussions for being found guilty of Medicare or Medicaid fraud can vary, depending on:

• Whether the offender has a history of similar crimes
• The sentencing guidelines
• The degree of harm caused by the fraudulent acts
• Other factors deemed relevant by the court

Penalties include:

• Incarceration
• Probation, which may be granted in some cases
• Heavy fines
• Mandatory restitution payments
• Exclusion from all government health programs
• Possible loss of one’s professional license

Seek Legal Representation for Medicare Fraud Charges

By taking your Medicare fraud or abuse case to The Law Offices of Richard Kuniansky, you can feel confident that it is being handled by a seasoned attorney. It’s important to have a legal professional on your side to protect your rights and speak on your behalf. Contact us today to schedule an initial consultation.