Medicare and Medicaid Fraud

The Medicare system represents a huge portion of government expenditure, and the work involved in simply processing claims and paying providers leaves few resources available for validating those claims. Oftentimes, Medicare simply pays the claims without much investigation into potential fraud and abuse. As a result, Medicare fraud is rampant nationwide, costing taxpayers billions of dollars in Medicare funds.

With limited funds available to investigate Medicare fraud, the federal and state governments rely on whistleblowers to report fraudulent activity. The qui tam provisions of the False Claims Act provide generous incentives and strong protections for whistleblowers who file qui tam lawsuits on the government’s behalf.

Contact us or call 800-533-1015 for a free consultation today.

Types of Medicare and Medicaid Fraud

Nearly every part of the healthcare industry provides opportunities for unscrupulous persons and entities to defraud Medicare. Under the False Claims Act, any claim for Medicare payment that is tainted by any illegal activity or noncompliance with established regulations could potentially be considered Medicare fraud. Common types of Medicare fraud include:

  • Billing Medicare/Medicaid for any good or service that is not medically necessary
  • Billing Medicare/Medicaid in a way that does not accurately represent the goods or services provided, such as upcoding or billing for services not rendered
  • Noncompliance with FDA regulations for suppliers of pharmaceuticals, medical devices or equipment, and other healthcare products
  • Improper or noncompliant documentation of medical necessity and other information
  • Violations of the Anti-Kickback Statute
  • Stark Statute violations

While not all inaccurate Medicare billing necessarily involves intentional fraud, healthcare providers and manufacturers of drugs and medical equipment must diligently adhere to all applicable regulations to avoid potential False Claims Act violations. However, many players in the healthcare industry continue to submit false or fraudulent Medicare claims hoping to avoid detection.

It is important to keep in mind that Medicare fraud is not just stealing from the government. In many cases it also represents a public safety risk as well. Healthcare providers who act out of their financial self-interest rather than in the best interest of patients may provide substandard and unsafe treatment to patients.

The attorneys at Kenney & McCafferty have the skills and experience to hold wrongdoers accountable for their fraudulent actions — and help you maximize your whistleblower rewardContact us or call 800-533-1015 for a free consultation today.

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