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The Basics of Medicare Fraud

Healthcare Fraud By Harvey Binnall PLLC - 2018/11/16 at 06:58pm

Medicare is a federal “socialized” health insurance program that provides health insurance to seniors and disabled persons.  Recent estimates peg Medicare participation at over 58 million individuals overall, most of which who are seniors.

Given the prominent role that the Medicare program plays in American healthcare, it’s no surprise that fraud is commonplace.  On an annual basis, billions of dollars are extracted from the system due to fraud — false billing and other instances of fraud — which hurts taxpayers and erodes trust in our healthcare institutions.

Prosecutors are quite aggressive when it comes to litigating Medicare fraud cases, as strict legal enforcement is crucial for discouraging medical providers from engaging in similarly fraudulent activity.  If you’ve been charged with Medicare fraud, it’s important that you connect to an attorney who is familiar with the challenging legal landscape.  Contact Harvey & Binnall, PLLC for further assistance.

Elements Underlying the Medicare Fraud Charge

Medicare fraud — like other forms of fraud — involves the illegitimate collection of funds from the Medicare program, typically by an individual medical provider or healthcare organization, such as a private clinic.  Stated simply, Medicare fraud occurs when a claimant uses deception to obtain or induce remuneration relating to the Medicare program.

Common examples of Medicare fraud include:

  • False billing
  • Excessive billing (i.e., provision of nonessential treatments)
  • Patient kickbacks for fraudulent billing
  • Phantom billing of patients that don’t exist
  • Upcoding procedures to secure higher reimbursement
  • And more

Intent is Fundamental to Medicare Fraud Liability

If you’ve been charged with Medicare fraud, there are a number of strategies that you can utilize to avoid liability — perhaps the most common is the assertion that you did not actually intend to commit fraud.  Intent is central to a fraud charge.  Without intent, there is no criminal fraud.

For example, if you accidentally used a billing code for a more expensive procedure, but did not realize that you were doing so, then you could not be liable for Medicare fraud.  Mistakes cannot give rise to criminal liability for Medicare fraud.

Proving intent is not an easy task for prosecutors, and as such, unless they have clear evidence linking your actions to a specific criminal intent to commit Medicare fraud, they may not be able to establish guilt.  Given this inherent difficulty, you are likely to have significant bargaining power during pre-litigation negotiations with prosecutors (unless the evidence is clearly unfavorable to your position).

Contact an Alexandria Healthcare Fraud Lawyer for Defense Litigation Assistance

Harvey & Binnall, PLLC is a boutique white collar criminal defense and litigation firm located in Alexandria, VA and serving clients throughout Virginia, Maryland, and the Washington D.C. metro area.  Our attorneys have extensive experience representing defendants in various white collar criminal disputes, including those that involve allegations of Medicare fraud.

We pride ourselves on our commitment to highly-engaged, client-centered service.  We work with clients to understand their case in a comprehensive manner, and to ensure that we are fully informed of relevant facts moving forward.  This thorough approach to white collar criminal defense has helped us successfully defend numerous clients over the years.

We encourage you to request an appointment online to speak to an experienced Alexandria healthcare fraud lawyer at Harvey & Binnall, PLLC.