Medicare fraud occurs when an individual, medical team, pharmaceutical company or healthcare facility claims reimbursement from Medicare for services to which they are not entitled. Medicare fraud is a widespread problem, detrimental to everyone who depends on Medicare services, not to mention the whole country. Medicare fraud costs the government, and therefore the taxpayers, billions of dollars annually. If you have direct knowledge that anyone you know is committing Medicare fraud — whether it is a doctor, healthcare facility or a pharmaceutical company — you should contact an accomplished whistleblower attorney promptly.
Your quick action may help prosecute those whose fraudulent acts are wreaking havoc with our Medicare safety net and may earn you a reward in the process. Jeffrey Newman Law, located in Massachusetts, serves courageous clients throughout the country. Founding attorney, Jeffrey Newman, has the experience and know-how to channel your concerns into a winnable lawsuit that has the potential to filter out corruption from the Medicare system and provide you with a significant financial reward for your good deed. You should be aware that whistleblower evidence is processed on a “first to file” basis. This means that you must be the first to bring your case forward in order to collect the reward.
Defining Medicare Fraud
Medicare fraud occurs when any one person or company intentionally deceives Medicare for personal gain. In some cases, Medicare is billed for healthcare services that were never provided; in others, Medicare is billed for a much higher amount than was actually spent. Medicare fraud also occurs when therapy or medical services are rendered and billed, but those services were not medically necessary. So much Medicare fraud occurs that a special organization has been created to police possible offenders. The program is known as the National Health Care Anti-Fraud Association (NHCAA).
Varieties of Medicare Fraud
Because Medicare is such an enormous, multi-layered healthcare system, many people have found ingenious ways to scam the program. Among these are:
- Billing for services never provided by falsifying medical records and documents
- Charging for more expensive services than those that were actually provided (upcoding)
- Performing unnecessary procedures in order to pad bills
- Charging separately for each step in what is actually a single procedure (unbundling)
- Overprescribing unnecessary medications which may harm (or even kill) patients
- Faking a diagnosis or suspicion of a condition in order to be paid for additional tests
According to the NHCAA, one of the most frequent types of fraud is the false classification of cosmetic surgeries as medically necessary procedures. A common example of this type of fraud is when plastic surgeons bill for a deviated septum when actually performing a rhinoplasty (nose job) for aesthetic reasons alone.
As noted, there are many ways of defrauding Medicare, some no doubt being invented as you read this article. Some others are:
- Waiving Medicare copays and deductibles when financial hardship of the patient cannot be established through documentation in order to receive favors or kickbacks
- Receiving kickbacks for referring patients to particular healthcare facilities or for prescribing particular drugs in return for illegal benefits — e.g. cash, cars, trips
- Continuing to bill Medicare for rented medical devices or equipment when the products have already been returned to the supplier
All types of Medicare fraud have the same goal: to collect money illegally from the Medicare program. Such actions are taken seriously by the government and punished severely.
Laws Under Which Medicare Fraud is Prosecuted
The Centers for Medicare & Medicaid Services (CMS) points to several federal laws under which Medicare fraud is prosecuted:
Criminal Health Care Fraud Statute
The Criminal Health Care Fraud Statute is probably the broadest of the federal laws related to Medicare fraud since the statute makes it illegal to intentionally defraud any federal healthcare benefit program by using false statements to obtain funds.
The False Claims Act makes it illegal to overcharge the government. Under this statute’s qui tam provision, individuals with evidence of fraud against federal programs are permitted to sue the defendant on behalf of the federal government. If you have such evidence, contacting Jeffrey Newman Law is a wise move. We have the experience and tactical skills to help you navigate the justice system, combating fraudulent activity and possibly being able to claim a portion of the damages in the process.
It is unlawful to receive anything of value in exchange for Medicare-related services. Whether an individual accepts cash, restaurant meals, theatre tickets or low-rent office space in exchange for referring patients to doctors, nursing homes or physical rehabilitation centers, or for prescribing particular medications, this behavior constitutes fraudulent activity. The Anti-Kickback Statute provides both criminal and civil penalties for violations.
The Stark Law forbids doctors from referring Medicare patients for treatment at facilities with which they have any financial relationship. This means that doctors are not legally permitted to send their patients to their immediate family members for treatment or to a spa or rehabilitation facility with which they are in any way financially offilated. The Stark Law, unlike the Anti-Kickback statute, punishes the offender for a civil violation only. Still, “Physician Self-Referral” (another name for the Stark Law) imposes steep financial penalties.
Penalties for Medicare Fraud
Because Medicare fraud is so costly and otherwise damaging to our healthcare system, the penalties for Medicare fraud are especially harsh. The government encourages whistleblowers to come forward and report fraud by awarding them a percentage (15-30%) of what the government recovers. If there is a favorable settlement or jury verdict in a False Claims Act care, the defendant faces civil penalties for each offense plus up to treble damages (three times the value of the government’s loss).
Contact Our Medicare Fraud Whistleblower Attorney
Because schemes to defraud Medicare are designed not to be detected, they often remain camouflaged, buried in paperwork and/or computer files where only insiders have access to them. If you become aware of irregularities in the healthcare office in which you work, or at which you are treated, you owe it to yourself and the community at large to reach out to Jeffrey Newman Law for assistance. Our offices will help you accumulate precisely the documentation you need to file your claim and guide you through the judicial process. In many cases, working closely with our accomplished lead attorney will bring you substantial monetary awards as well the satisfaction of knowing you have done the right thing.