Fraud Against The Federal Medicare Program
What is Medicare?
The Medicare Program is a Federal program that provides healthcare coverage for 57 million Americans who are over the age of 65 or disabled. With more than $540 billion in annual expenditures, it is no wonder that Medicare Fraud continues to cost taxpayers tens of billions of dollars a year.
What is Medicare Fraud?
Medicare Fraud occurs when healthcare providers knowingly submit claims to Medicare that are inflated or not eligible for reimbursement. The Medicare program is separated into four different “Parts,” including Part A (hospital stays, skilled nursing and home health), Part B (physician services, outpatient drugs and laboratory testing); Part C or Medicare Advantage (managed care plan options), and Part D (prescription drug coverage). Fraud affecting any program or plan funded by these Parts can be considered Medicare Fraud.
What are some common Medicare Fraud schemes?
Some of the most commons forms of Medicare Fraud include:
- Double billing;
- Up-coding;
- Billing for services that were not provided or not medically necessary;
- Kickbacks schemes;
- Physician Self-Referral Law, also known as Stark Law, violations;
- Pharmaceutical marketing violations, including off-label marketing;
- Inflating patients’ risk scores for managed care plans;
- Improperly inflating drug pricing measures such as Average Sales Price;
- Hospice fraud;
- Improper inpatient admissions or prolonging Part A hospital stays;
- Unnecessary laboratory testing and physician kickbacks; and
- Fake clinical trial and research schemes.
How is Medicare Fraud Different than Medicaid Fraud?
Medicare is administered by the Federal Government, meaning False Claims Act cases for Medicare Fraud must be brought under the Federal False Claims Act. Many types of Healthcare Fraud cases involve both Medicare and Medicaid, meaning many cases are simultaneously brought under the Federal False Claims Act and each State’s False Claims Act.
What can I do to stop Medicare Fraud?
If you have knowledge and proof that a company or individual is submitting false claims in relation to Medicare Fraud, then give us a call today for a free consultation and case review with an experienced whistleblower attorney.
This information is for educational purposes. It is not offered as and does not constitute legal advice or legal opinions. You should not act or rely upon this information without seeking the advice of an attorney.
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