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Understanding Medicare and Medicaid Fraud

Medicare Fraud

Health care fraud in the United States can take many different forms, including Medicare and Medicaid fraud. Depending upon the specific way in which a person is accused of engaging in Medicare or Medicaid fraud, that person may face fraud charges under the federal health care fraud statute, as well as under other federal fraud statutes criminalizing wire fraud, bank fraud, or mail fraud, or under the federal False Claims Act. In many cases, a person will face multiple types of charges related to the alleged Medicare or Medicaid fraud. Whether you have been arrested for Medicare or Medicaid fraud, you are already facing charges, or you are merely concerned that you are under investigation, you should seek advice from an experienced Dallas federal fraud defense attorney who can help.


What is Medicare and Medicaid Fraud?

What is involved in allegations of Medicare and Medicaid fraud? These types of allegations are allegations of a form of white collar crime. White collar crimes are aimed at gaining an unfair financial advantage. Although these types of fraud crimes do not involve any acts of violence, they are treated extremely seriously under federal law. Indeed, Medicare and Medicaid fraud, along with many other types of health care fraud, can result in significant prison sentences and substantial monetary fines.

When it comes to Medicare and Medicaid fraud specifically, the Centers for Medicare and Medicaid Services (CMS) explains that these forms of fraud involve “the intentional providing of false information to get Medicaid [or Medicare] to pay for medical care or services.”


Common Examples of Medicare and Medicaid Fraud

There are many different forms that Medicare and Medicaid fraud can take, and many different types of parties can face charges. For example, a health care provider could face charges, a patient could face charges, or another party outside the doctor-patient relationship could face charges. According to CMS, the following are some of the most common forms that Medicare and Medicaid fraud take:

  • Intentional billing for unnecessary medical services or medical items;

  • Intentionally billing for medical services or items that were never provided;

  • Billing for multiple codes to obtain additional money, or “unbundling”;

  • Billing for more complex services, or “upcoding”;

  • Treating a patient other than the Medicare or Medicaid recipient and knowingly billing for the services;

  • Filing false claims for Medicare or Medicaid reimbursement;

  • Writing unnecessary prescriptions and selling them at a higher cost;

  • Receiving kickbacks for referrals or services;

  • Billing Medicare or Medicaid for a beneficiary who is ineligible;

  • Giving another person your Medicare or Medicaid identification to receive medical services;

  • Receiving unnecessary tests so your doctor can bill for them;

  • Accepting kickbacks from a health care provider for referrals;

  • Selling fraudulent Medicare or Medicaid identification documents; or

  • Providing false information to Medicare or Medicaid to unlawfully qualify for coverage.


Contact Our Dallas Health Care Fraud Defense Lawyers for More Information

Healthcare fraud charges need to be taken extremely seriously. If you have been accused of Medicare or Medicaid fraud, or if you are concerned that you are under investigation for health care fraud, it is critical to seek advice from one of our Dallas health care fraud defense attorneys as soon as possible to begin working on your defense. Contact the Law Office of Patrick J. McLain, PLLC today to learn more about how we can assist you.

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