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Defenders Of The Accused
Matthew Radefeld & Dan Juengel

3 examples of Medicare fraud

| Mar 14, 2019 | Uncategorized |

If you work at a medical provider’s office, you probably know that fraud is running rampant throughout the health system. With access to Social Security numbers and addresses, it is easy to steal identities and money from people who patronize the provider.

You may find yourself in the situation where the police believe you had a hand in an attempt to defraud Medicare. Whether you have or not, it is a good idea to get an understanding of the signs police look for in trying to build a case of fraud.

1. Billing medical equipment

One way to find yourself under the microscope is by billing durable medical equipment unnecessarily. If a patient does not need the items, yet they wind up on a Medicare invoice, the authorities may come knocking.

2. Billing for services never rendered

Providers may find themselves running short on cash in any given month due to slow-paying clients and insurance companies. Medicare typically pays on a set monthly schedule, so getting a little extra cash from them seems like a way to boost cash flow. Billing Medicare for services that were never performed is another form of fraud, and depending on what the amount adds up to, you can find yourself in court as a result.

3. Billing services not eligible for coverage

Medicare has a strict list of what services it covers and what it does not. Certain tests and procedures may not fall under this umbrella. Sometimes, however, a patient may warrant these extra items and providers may change medical codes to push the coverage through. While doing this may help a patient, it is still fraud.

You may have inadvertently committed an act of Medicare fraud, and if you do, it is a good idea to know what you may face. If you or your employer has done this, check with a knowledgeable criminal defense attorney to learn what steps you need to take to battle the charges.