Medicare / Medicaid / Tricare Fraud

While federal healthcare benefit programs such as Medicare, Medicaid, and Tricare can make it easy for many patients in Michigan to receive a wide variety of medical care at a reasonable cost, the administrative burden on providers is often immense. Insurance codes, legal requirements, and other issues can make it extremely difficult to complete billing procedures properly.

As a result, healthcare providers may be accused of billing fraud for errors that were purely unintentional. Penalties for fraud involving Medicare and other federal programs could be substantial and may include criminal sentences, civil sanctions, and other consequences.

A Michigan Medicare/Medicaid/Tricare fraud lawyer may be able to help if you are facing allegations of fraud involving federal medical benefits. A knowledgeable healthcare fraud attorney could fight to protect your rights and devise the right defensive strategy for your situation to pursue a positive outcome in your case.

As a general term, fraud refers to making a deliberately false statement to deceive another person and receive illegal gain. If one person pretends to be another person and uses that person's credit card to buy merchandise, for example, that would be fraudulent use of a credit card.

Concerning Medicare/Medicaid/Tricare and other healthcare programs, fraud may be committed in several ways. Some interpretations distinguish fraudulent practices from abusive practices and consider abuse to occur when a healthcare practice provides services that are not up to standards or not medically necessary.

Whether it is called abuse or fraud, if the practice involves attempting to gain a benefit based on knowingly false information, it could be prosecuted as fraud under federal law. Because states individually administer Medicaid, the Michigan Attorney General's office may also prosecute some healthcare fraud cases involving federal programs. You could speak with a Michigan attorney to understand the nature of your Medicare/Medicaid/Tricare fraud and what legal options you may have available.

Both providers and patients may commit fraudulent practices involving improper reception of benefits from Medicare, Medicaid, and Tricare. Actions that violate the law may involve billing, physician certification, falsified records, kickbacks, or other issues. More specifically, a Medicare/Medicaid/Tricare fraud lawyer in Michigan may be able to help with allegations of:

• Billing for services never provided
• Billing for services that were more complex than those actually provided
• Falsely certifying that medical equipment was necessary when it was not
• Accepting or providing kickbacks for referrals
• Billing separately for services that should have been bundled
• Illegally dispensing or selling prescription medications
• Billing for services for a patient who was not authorized to receive such services

In certain cases, allegedly fraudulent practices may be committed by an outside billing firm. It is often easier to reduce the consequences resulting from such a practice if it can be shown that the practice was appropriate or, if inappropriate, that it was committed as an honest mistake.

Fraud in connection with Medicare/Medicaid/Tricare may be addressed through the legal system under a number of different statutes, some of which provide criminal penalties that could require representation from a qualified Michigan lawyer to contest. Even if criminal penalties do not apply, those found to have committed instances of healthcare fraud may still be required to pay fines, damages, court costs, and attorneys' fees. Moreover, they may become ineligible to receive federal healthcare funds in the future.

Claims may be brought under the federal False Claims Act, anti-kickback statutes, healthcare fraud criminal prohibitions, the Stark Law, or other federal legislation. As an example, 42 U.S.C. §1320a-7b provides criminal penalties for misrepresenting a material fact when seeking payment under a federal healthcare program such as Medicare, Medicaid or Tricare. Those found guilty face up to 10 years in prison and a fine of up to $100,000.

Given the potential severity of the consequences, it could be wise to take a proactive stance when it comes to allegations of Medicare/Medicaid/Tricare fraud. If you are charged or believe you may be under investigation for fraudulent practices, it may be advisable to consult a tenacious Michigan Medicare/Medicaid/Tricare fraud lawyer.

A seasoned legal advisor can explain the potential ramifications of such accusations and use every available means to contest associated charges. An experienced attorney could also help monitor for compliance or establish procedures for future protection. Call today to learn more.