A NY Healthcare Fraud Lawyer Explains Medicare Insurance Fraud
Medicare is a federal program that provides health insurance coverage to the elderly and to the disabled who have been receiving Social Security Disability Insurance for at least 24 months. Medicare covers the majority of costs of hospitalization, as well as routine medical care. Patients may also opt to purchase supplementary Medicare coverage for prescription drugs as well as Medicare Advantage plans that offer more comprehensive coverage.
Providers who accept Medicare payments are subject to strict regulations to ensure that only legitimate benefits are paid. In some circumstances, however, patients receiving Medicare coverage or providers offering treatment to Medicare patients are accused of fraud. A fraud accusation can trigger civil and criminal penalties and must be taken very seriously. If you have been accused of Medicare insurance fraud, contact Bukh Law Firm, PLLC today to get help responding to fraud charges.
What is Medicare Insurance Fraud?
The Centers for Medicare Services (CMS) defines Medicare insurance fraud to include: “an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person.”
Both fraud and abuse are considered criminal behaviors. Abuse is defined by CMS as: “provider practices that are inconsistent with sound fiscal, business, or medical practices, and result in an unnecessary cost to the Medicaid program, or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care.”
Whether a given billing practice constitutes fraud or abuse may be a subjective question. A prosecutor has the burden of proving fraud beyond a reasonable doubt in order for you to be convicted of a crime related to Medicare insurance fraud. Bukh Law Firm, PLLC has extensive experience helping providers accused of insurance fraud crimes to make a jury doubt whether a crime has been committed.
Types of Medicare Insurance Fraud
Providers may be accused of many different types of Medicare insurance fraud schemes including:
- Billing for services that are not actually performed.
- Performing and/or billing for services that are not medically necessary.
- Performing and/or billing for services more costly than those performed, provided, or necessary (upcoding).
- Billing separately for services that are bundled together and that should be billed under one insurance code (unbundling).
- Paying illegal kickbacks for referrals
Individuals can also commit Medicare fraud, such as when trying to obtain medical services using someone else’s Medicare identification.
Any of these types of fraud can trigger an investigation. For many health providers, even a suspicion of fraud will result in the government temporarily freezing assets under 18 U.S. Code Section 1345 or seizing funds through criminal or civil forfeiture under 18 U.S.C. Section 982. You must act proactively if you are accused of Medicare insurance fraud so you can protect yourself and build a strong case to keep your freedom and funds.
Medicare Insurance Fraud Penalties
There are both civil and criminal consequences associated with Medicare insurance fraud:
- 18 U.S.C. Section 1035 makes it a crime to make false or misleading statements in connection with delivering healthcare services. The maximum potential penalty is five years imprisonment for this offense.
- 18 U.S.C. Section 1347 makes it a crime to participate in any scheme or artifice with the goal of defrauding health insurers in connection with health care benefits. False promises, material misrepresentations or any other intentional fraudulent acts can result in up to 10 years imprisonment under this federal law.
- 42 U.S. Code Section 1320a-7B addresses illegal kickbacks and false statements on applications for benefits under federal healthcare programs like Medicare and Medicaid. The potential penalty is up to five years imprisonment.
- 42 U.S. Code Section 1320a-7a imposes a civil fine of $10,000 per incident of healthcare fraud.
When you are being investigated by state or federal authorities, you need to understand the possible charges you are facing so you can begin building the strongest defense possible to avoid conviction. A criminal defense lawyer with experience in Medicare insurance fraud cases can also help you try to negotiate a plea deal to face a reduced penalty.
How a Healthcare Fraud Lawyer Can Defend Against Insurance Accusations
Many providers are accused of fraud even when they had no intention of making inappropriate claims for Medicare payments. An accusation of fraud does not have to result in a criminal conviction if you can build a strong case to fight for your freedom. Call Bukh Law Firm, PLLC for help fighting a charge of Medicare fraud.
