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Common Types of Medicare Fraud

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According from a report published in The Economist last year, Medicare fraud and other forms of healthcare fraud cost the federal government $272 billion per year. This amounts to roughly 10 percent of the nation’s annual healthcare budget of $2.7 trillion. As a result of the sheer size of the problem, the U.S. Department of Health and Human Services (DHHS), the Centers for Medicare and Medicaid Services (CMS), and other federal agencies are vigorously pursuing fraud claims nationwide.

Understanding Medicare Fraud

Medicare fraud takes many forms, though at its core it involves claiming government funds that are not rightfully owed. Some of the most common types of Medicare fraud include:

  • Falsifying records
  • Billing for services that were not rendered or that were not medically necessary
  • Charging excessive rates for services, equipment, or supplies
  • Upcoding, code jamming, and unbundling services
  • Paying, accepting, or soliciting kickbacks to affect government healthcare contract awards
  • Making prohibited referrals

In order to face charges, it is not necessary to intend to defraud the government – or even necessarily to know that you are engaged in illegal activity. While the structure (or, some would say, lack thereof) of the Medicare system makes it ripe for both intentional and unintentional abuse, the laws surrounding the system provide swift punishment for those found to be engaged in fraud.

Recent, Real-World Examples of Medicare Fraud

The following are all examples of real-world cases involving various forms of Medicare and healthcare fraud that were investigated and prosecuted by the federal government:

  • In a nationwide “takedown,” the federal government arrested 90 people in six cities, 16 of whom were doctors and one of whom allegedly submitted more than $24 million in fraudulent claims for power wheelchairs.
  • In 2013, the owner of a mental health clinic was sentenced to 30 years in federal prison for fraudulent billing.
  • In a broad investigation, the DHHS’s Medicare Fraud Strike Force visited 1,600 businesses that had been billing Medicare for durable medical equipment. Nearly a third of the businesses – which had billed Medicare for $237 million in the previous year alone – were found to not actually exist.
  • In a prescription drug fraud scheme, one clinic was found to have billed the government for $12 million in oxycodone prescriptions at $300 a piece that were then sold to fake patients for $30 to $90. The “patients” were often handed scans and urine samples at the door.

You can read more examples on the Medicare Fraud Strike Force website.

Of course, not all cases of Medicare fraud are this extreme, and not everyone accused (or convicted) of Medicare fraud is involved in a criminal enterprise. However, anyone convicted of Medicare fraud can face life-changing, and in some cases career-ending consequences. To protect yourself, if you are under investigation for Medicare fraud, you should speak with an attorney right away.

Contact Oberheiden, P.C. | Nationwide Medicare Fraud Defense Lawyers

To learn more about the consequences of Medicare fraud, we encourage you to contact us for a free, confidential case evaluation. Our legal team draws on decades of broad experience and is prepared to do whatever it takes to help you win. To get started, call (800) 701-7249 or contact us online today.

Orange County 714-294-2000
Los Angeles 310-873-8140
Detroit 313-888-8807
Nationwide 888-452-2503