What actions count as Medicare fraud?

On Behalf of | Nov 26, 2018 | Fraud

A California doctor was convicted earlier this year for receiving illegal kickbacks for Medicare referrals. According to the United States Department of Justice, evidence showed that he and others referred Medicare patients to a California home health agency in exchange for kickback payments. Medicare paid about $4.1 million toward the claims that resulted from those referrals. The doctor will be sentenced for this crime in January.

The doctor’s actions are illegal based on the anti-kickback statute, which prohibits anyone knowingly and willingly offering, paying, soliciting or receiving direct or indirect payment for referrals for items or services provided by Medicare or other federal health care programs.

Violating the anti-kickback statute is only one way doctors sometimes commit Medicare fraud. Other potential types of Medicare fraud include:

  • Knowingly submitting or causing the submission of false Medicare claims, such as claims submitted for a higher level of services than the doctor actually provided.
  • Referring health services that Medicare pays for to an entity in which the doctor has an investment interest.
  • Knowingly and willingly executing a scheme connected to the delivery of health care benefits, for example, doctors and clinics working together to submit medically unnecessary claims.

The penalties for Medicare fraud vary, depending on the specific incident that has occurred, but can earn both civil and criminal penalties that can include heavy fines, imprisonment or both. Because the penalties can be severe, it is important for doctors facing Medicare fraud charges to explore every legal option available to them.

FindLaw Network
Gary Jay Kaufman
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