What should I know about allegations of Medicare abuse and fraud?

On Behalf of | Jul 1, 2022 | Health Care Fraud

A key to starting, building and maintaining a successful medical practice is based on reputation. To have allegations about any type of fraud can be severely negative to the medical professional’s business. This can go beyond the criminal charges and hinder the future.

Since the government will scrutinize the Medicare bills they are asked to pay, people who might have misunderstood the rules, made an honest mistake or even done something they should not have done could face a litany of charges that can harm the with criminal accusations and the long-term ramifications that go along with it. Understanding this is crucial with allegations of Medicare fraud or Medicare abuse.

Key points about Medicare fraud and Medicare abuse

Medical professionals are expected to be above board with charging Medicare for treatment they have given to patients. They are also expected to adhere to protocol when referring patients, dealing with vendors and asking for payment from the government.

It is a fact that some people might flout the law and overcharge or say they did treatments on patients that they did not. There could be an issue with simply being in the wrong place at the wrong time with people who are committing violations when a person who is charged was innocent. Improper relationships with other physicians, vendors and payers are common catalysts for fraud charges.

Those who submit wrongful claims and know they are doing so to get paid from the government are committing fraud. If there is an offer to commit some form of fraud for compensation, this too is a form of Medicare fraud. Kickbacks, bribes, referrals that are prohibited – these are all aspects of fraud.

Medicare abuse is if medical professionals are not following the applicable standards of care or are giving patients services they do not need just to receive payment. They might say they performed a procedure they did not; they could overcharge; and billing codes on a claim could be submitted wrongly. Criminal charges can be filed for those who are accused of these violations.

There are options when accused of Medicare violations

It takes many years to become a doctor or other medical professional and one accusation of wrongdoing and subsequent charges has the potential to tear the person’s career and personal life apart without warning.

In some cases, a person accused was unaware that the clinic or practice they worked for was engaged in wrongdoing. They might have taken part in steps to hide what happened giving rise to the adage: It’s not the crime, it’s the cover-up. This tends to make the situation worse.

Fortunately, there are avenues to explore to fight the charges of Medicare fraud. Explaining the situation to experienced professionals who are not only skilled with crafting a defense but are well versed in the court system can be a good head start to reaching a positive outcome.

The anxiety and worry are often the worst part of this type of case and the sooner that is assuaged, the better. To avoid the harshest penalties, try to forge a viable solution and keep from the “dirty doctor” label, it is imperative to have guidance with healthcare fraud from the start. Consulting with affable and skillful legal professionals is the first step.