What Counts as Healthcare Fraud for Medicare and Medicaid?

Florida sees a large number of Medicare and Medicaid fraud cases because of its high population of seniors and the size of its healthcare system. Federal agencies watch these programs closely, and when they suspect fraud, they do not hesitate to investigate. Understanding how healthcare fraud is defined is the first step in protecting yourself.
What is Healthcare Fraud?
Healthcare fraud happens when a person lies, hides facts, or submits false claims in order to get paid by Medicare or Medicaid. Fraud requires intent. In other words, the person must have known what they were doing. Billing mistakes or paperwork errors are usually handled as compliance issues, not criminal cases. To charge someone with fraud, the government must show that the person meant to receive money they were not entitled to.
Common Medicare and Medicaid Fraud Schemes
False Billing:
Billing for services that did not happen, billing for procedures that cost more than the ones performed, or billing for the same service more than once.
Kickbacks and Referral Payments:
Offering or receiving money or gifts in return for sending patients to a particular clinic, doctor, pharmacy, or lab that bills Medicare or Medicaid. These payments can involve marketers, doctors, and medical companies.
Billing Under Someone Else:
Submitting claims under a licensed doctor’s name when the work was done by someone not licensed or not qualified.
False Records or Diagnoses:
Changing or adding information in a patient’s chart to justify billing. This includes making a condition seem more serious than it is in order to get paid.
Patient Fraud:
Patients can also commit fraud by using someone else’s Medicare or Medicaid information or getting medical equipment they do not need.
If You Are Being Investigated in Florida
Healthcare fraud cases can result in large fines, long investigations, and possible jail time. If you believe you are under investigation for Medicare or Medicaid fraud, contact experienced criminal defense attorney Michael B. Cohen to protect your rights and discuss your next steps.