Medicare Fraud

Medicare fraud in Miami has been a priority for South Florida prosecutors for several years now. The government has been extremely aggressive in combating this type of fraud. This zealous prosecution has not been without numerous mistakes. Many of our clients have been forced to undergo investigations and even arrests for minor, inadvertent billing errors or discrepancies.

As a white collar crime, Medicare fraud may result in grave implications for those facing these charges. Individuals that oversee healthcare facilities or utilize the Medicare program should be aware of what comprises illegal activities. Physicians and business owners in Florida are common targets of audits and investigations into Medicare fraud. Countless reputable cardiologists, surgeons, and business owners end up becoming suspects of fraud, finding themselves as defendants each year in Florida due to actions taken by auditors and prosecutors to cut down on such crimes.

Investigators may suspect potential Medicare fraud charges when the Centers for Medicare and Medicaid Services (CMS) receive a substantial volume of claims from a sole healthcare provider. Even if the provider is based in an area where people of lower income live or there is a significant population of senior citizens that will drive up the amount of Medicare claims, CMS may request an audit to confirm the honesty of the claims. Hence, due to claim amounts, even a reputable healthcare provider overseen by honest, trained professionals that adhere to the best practices for making Medicare claims may find themselves facing audits.

CMS has indicated multiple ways in which Medicare fraud crimes can be committed. The following fraudulent activities are also illegal, besides billing the program for services that were not performed:

  • Permitting someone else to utilize a Medicare card belonging to another person for the purpose of procuring services or supplies.
  • Attempting to bill Medicare for equipment that was never acquired.
  • Providing misleading information to others to lure them into signing up for a Medicare plan.
  • Sending an invoice for services performed at a lower level than the higher code level suggests.
  • Developing a fake patient profile and then billing for services that were allegedly provided to the fictional patient.

Intentionally providing that is incorrect or falsifying the truth to seek payments may lead to charges of fraud. As an example, inflating charges to Medicare for services actually delivered may still be deemed fraudulent due to it misrepresenting fact.

Medicare fraud is considered a federal criminal offense. There are a number of federal laws in place designed to regulate the way Medicare fraud is prosecuted and punished, according to CMS. The False Claims Act, for instance, makes it a crime if the government is overcharged. The punishments for doing so may include a fine of several thousand dollars, as well as a penalty which may be as much as three times the amount of damages incurred by the unlawful actions.

Depending on what has happened, criminal charges may also be filed. Anyone accused of a white collar crime could be sentenced to time in prison.

A critical aspect of Medicare fraud is that the individual in question must have deliberately committed the act or acted rashly or negligently for the fraud charge to be deemed a felony. Thus, if anyone in Florida loses his or her Medicare card and someone else utilizes the account details, the original cardholder will not necessarily be liable or responsible for the damages incurred.

Something like a coding error may also trigger an inquiry into fraud. A breach of billing or coding may be a pure misunderstanding, rather than a suspected attempt to defraud the government.

The general information provided above about Medicare fraud in Fort Lauderdale is meant for educational purposes only and is not a substitute for speaking directly with an attorney about the facts and circumstances of your case. Please call 954-500-0003 in Broward or 305-674-0003 in Miami to schedule a consultation with the Law Offices of Mark Eiglarsh.

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