- Billing for services that were never performed.
- Providing services that aren’t medically necessary.
- Upcoding of services.
- Offering and paying kickbacks to doctors or Medicare beneficiaries.
- Submitting fraudulent cost reports.
- Conspiring to commit healthcare fraud.
Mark J. Mandell, Esq.
If you are a health care professional, Medicare and Medicaid fraud allegations are serious. In addition to heavy fines and penalties, the government often seeks prison time to punish violators.
And that dual strategy of criminal and civil penalties, which are part of ramped-up fraud prevention efforts, has saved over $100 million in federal health care funds for the Western District of Michigan, according to U.S. Attorney Patrick Miles.
In the past few years, the attack on fraud has yielded 20 criminal convictions and health care companies paying over $5 million in fines. Mr. Miles and investigators with the U.S. Department of Health and Human Services said Michigan is experiencing issues with fraudulent activities, in part, because some firms, like home health care companies, do not have to be licensed by the state.
What officials call “mom and pop” pharmacies make up a significant portion of the spike in fraud, while physicians and other professionals have not seen an increase in fraud issues. One of the largest cases federal attorneys recently prosecuted involved six pharmacists with a Kentwood Pharmacy, where pharmacists were accused of illegally restocking and re-prescribing drugs.
The $100 million saved in Medicare and Medicaid costs is a significant amount given the area's relatively low population. In comparison, officials said, focused fraud prevention efforts in Miami, Florida have saved some $500 million in health care costs.
Mr. Miles also stated in a recent Gongwer Michigan Report that, as part of the effort, the U.S. attorney’s office has met with various health care providers, including pharmacists, physician assistants and nurse practitioners to explain what constitutes fraud and its consequences. And, he noted that those meetings, along with the ramped-up enforcement, have deterred individuals from trying to commit fraud.
Fausone Bohn, LLP Medicare and Medicaid Fraud Defense Attorneys have experience defending health care professionals, and, as former prosecutors, we understand the opposition’s mindset and strategy. Our Medicare and Medicaid fraud attorneys can help defend you against allegations of: