Among all types of criminal fraud that target the federal government, Medicare and Medicaid fraud are two of the most common. These two programs are misused and defrauded in a variety of ways, in part because the scope of these programs is so vast, making individual instances of fraud difficult to detect.
In an effort to counteract fraudulent activity, the federal government keeps track of certain Medicare and Medicaid billing practices that are often associated with illegal use. Although it is impossible to detect, prosecute and convict every person who commits or attempts to commit this kind of health care fraud, individuals who are convicted will find themselves facing severe consequences.
Common Types of Fraud Schemes
Listing every type of medical fraud is likely impossible because of the lengths that fraudsters will go to conceal their activities. However, there are a few scenarios that occur frequently in most cases of fraud that are brought to light. Some of these common fraud schemes include:
- Billing Medicare or Medicaid for expensive prescription medications, procedures or treatments while administering a less costly alternative in order to pocket the difference. Alternatively, some fraud cases involve billing of costly medications or treatments for a non-existent or deceased patient in an attempt to steal the payouts.
- Intentionally overestimating the cost of a treatment or medication in order to bill Medicaid for an amount that is greater than what was actually required.
- Filing a billing claim with Medicare or Medicaid for a procedure that was never performed or a treatment that was never administered.
- Using one of these programs to order health care equipment for a particular patient, then keeping the devices for use in a health care facility and never actually delivering them to the patient.
- Collaboration between patients and health care providers to stage costly treatments that are not actually required, then billing Medicare or Medicaid and sharing the compensation payouts.
Wrongful Medicare or Medicaid Fraud Charges
Because these programs are so frequently targeted by fraud schemes and because billing procedures are inherently complex, it is inevitable that the government will wrongly accuse some individuals of fraudulent activity. In these cases, a Medicare or Medicaid fraud attorney can attempt to prove that the government’s accusations are unfounded or in error.
For example, if a fraud attorney can submit evidence that a patient or health care provider had legitimate, sound reasons for billing the programs, the prosecution may not be able to secure a conviction. According to the United States Code, a convicted individual may be sentenced up to five years in prison and may be charged up to $250,000 in fines.
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