Medicare fraud is a serious type of white-collar crime. Someone facing these accusations could be looking at fines, time in jail and the loss of a professional license that could derail their career.
As such, it’s important to understand how Medicare fraud happens and what it may entail. Below are a few examples.
False claims and misrepresentations
First and foremost, if a physician knowingly makes false claims or misrepresents a patient’s condition, it can be an example of fraud. Perhaps they claim that the patient needs a certain type of treatment or medication that should be covered, but the person doesn’t actually need it.
Taking kickbacks
When physicians accept kickbacks, this is a form of payment or a bribe given in exchange for certain services. For instance, the physician may prescribe a type of medication that the patient doesn’t actually need just because they want a kickback for writing the prescription.
Billing for services that weren’t rendered
Another issue is when a physician bills Medicare but doesn’t actually provide the services. They may claim that they did because they want to get those Medicare payments. A similar issue could be billing for the same services repeatedly, even though they were only rendered once.
Unnecessary services and items
Finally, if a physician provides unnecessary medical items or services to a patient, that patient may have no idea that it’s a form of fraud. They think it’s legitimate, but it’s actually unneeded. Examples could include medication or healthcare devices, such as a nebulizer or a CPAP therapy device.
If you are facing accusations of fraud as a physician, you know how much is at stake, so it’s very important to understand exactly what legal defense options you have at this time.
