Medicare Fraud Lawyer Miami

What Is Medicare Fraud?

Under federal law, Medicare fraud/abuse comprises a variety of wrongful practices, such as submitting false claims or creating false medical records. Medicare Part A, B, and D may each be the subject of fraud or abuse. 

Below are some of the most common Medicare frauds.

Types of Medicare Provider Fraud 

Phantom Billing

One of the most common types of Medicare fraud is phantom billing. This is when a provider attempts to steal money from the federal government by billing a patient for medical procedures and services they never provided. 

In the same vein, some health care providers commit fraud by performing and then billing Medicare patients for medically unnecessary treatment. 

This type of fraud is especially common when providers get financial kickbacks for surgeries. 

Upcoding

Upcoding is when a health care provider charges a patient for more expensive medical services than what was provided. 

Upcoding may be committed in any health care setting, such as by primary care physicians (PCPs) or specialists. Medical oncologists, orthopedists, ophthalmologists, and psychiatrists are just a few examples. 

Unbundling

Unbundling is another type of improper coding. 

Medicare provides certain related medical procedures and services to patients at discounted rates through bundling. Unbundling (or “fragmentation”) is when a health care provider disregards the discounted/bundled rate by charging each service individually. 

Other Types of Medicare Fraud by Providers

A few other examples include:

• Self-referrals for services
• Billing unordered supplies
• Overuse of medical services
• Overuse of medical equipment
• Certifying medically unnecessary services, supplies, or equipment
• Waiving insurance copays
• Employing unlicensed staff
• Illegal or improper use of equipment

Medicare Patient Fraud and Abuse Charges

At Frank Schwartz, P.A., we defend both providers and patients charged with fraud.

Here are a few of the most common Medicare fraud charges we defend patients against:

• Writing or using forged prescriptions
• Using Medicare to obtain services you do not need
• Doctor shopping to get prescriptions from multiple doctors
• Obtaining prescriptions using Medicare and reselling them for profit
• Using another person’s health insurance to get medical services (identity theft or identity swapping)

If you are under investigation or have already been accused, it’s important that you contact our Miami Medicare fraud attorney immediately. We stand ready to fight for your rights.

Penalties for Medicare Fraud

If you’re convicted of Medicare fraud, the penalties can be astronomical:

• Damages may be up to three times the amount of the fraud
• Fees no less than $10,000 per fraud claim charged against you
• Deemed ineligible for Medicare programs
• Time in jail or prison

How Is Medicare Fraud Prosecuted?

Working together with federal, state, and law enforcement agencies, the Centers for Medicare & Medicaid Services (CMS) investigates and prosecutes Medicare fraud. With so many different agencies involved, every Medicare fraud investigation will take a different amount of time. 

The courts take health insurance fraud very seriously, especially since a conviction could end your career. Sadly, the prosecution often pursues harsher penalties than called for. That means your rights, your freedom, and your future could be on the line.

We are committed to reducing the impact of your criminal case, such as by getting charges dropped or penalties lowered. We’ll work to protect you and your future!

Related Medicare Fraud Law Violations

Medicare fraud may also lead to various law violations, some of which include:

• U.S. Criminal Code
• Social Security Act
• False Claims Act
• Stark Law
• Anti-Kickback Statute

Defenses for Medicare Fraud Allegations

There are many defenses that can be used in health care fraud cases. Lack of evidence and lack of criminal intent are two of the most common.

At Frank Schwartz, P.A., we will work one-on-one with you to build a strong, personalized Medicare fraud defense strategy.

Helping Clients Win Medicare Fraud Cases in Florida

Medicare fraud investigations can be highly intrusive and leave you encountering high fines. Our legal team at Frank Schwartz, P.A. will stand with you to ensure the highest level of protection of your rights, as well as defend your freedom. We do not shy away from trial courts, but we also work to settle cases out of court when possible.

With your case in our hands, you can feel confident knowing a skilled criminal defense team is working in your best interest. While no firm can guarantee victory, we will work to put the odds in your favor. We will use all our resources, explore every avenue, and do everything we can to protect your rights! 

Call (305) 707-7770 to speak to a Miami Medicare fraud lawyer in a free consultation.