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Medicare & Medicaid Fraud

Medicare & Medicaid Fraud
One of the more commonly prosecuted federal crimes involves health care fraud, or more specifically, Medicare and Medicaid fraud. On an almost quarterly basis, the Department of Justice proudly announces a “crackdown” on health care fraud, accounting for losses in the hundreds of millions of dollars. Those caught up in these prosecutions include licensed medical professionals, including doctors and nurses, but can also include anyone working in the health care industry.

Individuals in these cases are typically charged with various health care fraud-related crimes. These include conspiracy to commit health care fraud, violations of the anti-kickback statutes, money laundering and aggravated identity theft. The charges are based on a variety of alleged fraud schemes involving various medical treatments and services, including home health care, psychotherapy, physical and occupational therapy, durable medical equipment (DME) and prescription drugs. Defendants in these cases are typically alleged to have participated in schemes to submit claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, Medicare beneficiaries and other co-conspirators are allegedly paid cash kickbacks in return for supplying beneficiary information to providers. The providers will then, in turn, allegedly submit fraudulent bills to Medicare for services that are considered medically unnecessary or never performed.

Other federal laws allegedly violated in these schemes include
• The Health Care Fraud Statute;
• The False Claims Act;
• The Anti-Kickback Statute;
• Exclusion Provisions; and
• The Civil Monetary Penalties Law.
The Health Care Fraud Statute makes it a criminal offense to knowingly and willfully execute a scheme to defraud a health care benefit program. Health care fraud is punishable by imprisonment for up to 10 years and fines of up to $250,000.

The False Claims Act establishes civil liability for offenses related to certain acts, including knowingly presenting a false or fraudulent claim to the government for payment, and making a false record or statement that is material to the false or fraudulent claim. Knowingly includes not only actual knowledge but also deliberate ignorance or reckless disregard for the truth or falsity of the information. Some examples of potential False Claims Act violations in the health care fraud context include upcoding, billing for unnecessary services, billing for services or items that were not rendered, and billing for services performed by an excluded individual. While individuals and entities that make false claims are subject to civil penalties, and exclusion from federal health care programs, false claims made knowingly may also be subject to criminal prosecution and punished by up to 5 years in prison and a $250,000 fine.

The Anti-Kickback Statute prohibits the knowing and willful offer, payment, solicitation, or receipt of any remuneration, in cash or in kind, to induce or in return for referring an individual for the furnishing or arranging of any item or service for which payment may be made under a federal health care program. Criminal penalties for violation of this statute are a fine of up to $25,000 and imprisonment for up to 5 years.

To investigate and prosecute these crimes, the federal government has a Medicare Fraud Strike Force, a joint initiative between the Department of Justice and Health and Human Services to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. The Medicare Fraud Strike Force operates in nine locations and since its inception in March 2007 has charged over 2,900 defendants who collectively have falsely billed the Medicare program for over $8.9 billion.

Brent Mayr, Paul Schiffer, and Richard Esper represent a number of people who are under investigation for and charged with various health care fraud offenses and have the knowledge and experience to protect your rights and fight for you in court. If you or a loved one are in this position, contact Brent Mayr, Paul Schiffer, or Richard Esper at 855-NT-GILTY (855-684-4589) to speak with them personally regarding your case.

Feds crack down on health care fraud

CONTACT CRAIG WATKINS FOR PERSONAL INJURY, CAR ACCIDENT, CRIMINAL DEFENSE, OR CIVIL LAW CASES.

Craig Watkins is the former Elected District Attorney in Dallas County, Texas. He became the first elected African American District Attorney in the State of Texas. Craig served for two terms – 2007-2014. While District Attorney Craig set out to reform the criminal justice system with his Smart On Crime approach to criminal justice. This approach included the examination of wrongful convictions, rehabilitation, education, and employment. Craig created the first-ever Conviction Integrity Unit in a District Attorney’s Office in the Country.

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