What Is Medicare Fraud And The Role Of Medical Billing Attorney

Medicare fraud is one of the most significant issues that need to be addressed at the earliest. Government and law forcing agencies are striving to withhold the frequency of these frauds by awarding them with harsh punishments.

Undoubtedly, healthcare is the most divine profession that is responsible for the lives of human beings. Although, most of the physicians are trying to work ethically, and with a sense of duty. Yet, you can’t ignore the black sheep operating within this profession. What’s the most important thing in Medicare? Well, for most of us, it’s the trust between the physician and the patient. You can’t possibly imagine trusting someone who isn’t concerned with the quality treatment and is dishonest with his dealings.

If this happens, things can really turn into a nightmare. Well, to be precise, such ill practices are known to us as Medicare frauds. The ones within this field have the sole responsibility of securing the integrity of their Medicare program.

What is Medicare fraud?

Typically, medical fraud can be carried out by a single entity or even an organization in numerous ways. Some of them are penned down below

  • Knowingly submitting or exercising false claims. This is done in order to obtain federal health care payments. Although, the entitlement would never have otherwise expected unless you wouldn’t have falsely claimed it.
  • The worst frauds are knowingly submitting false and adulterated billing for services that cease to exist in your organization. However, in order for documentation processes, these false billing records are presented.
  • Some referrals are prohibited and carrying out those referrals to concerned medical services are also a part of Medicare fraud
  • Sometimes, some services and medical items aren’t needed. However, to get benefits knowingly these services are ordered.
  • Billing Medicare for appointments patients fails to keep.

These are some of the mentioned types of frauds usually conducted at this level. However, the situation is worsening by every passing day as these frauds are being carried out frequently the Medicare services that have hurt the integrity of this field.

Medicare fraud and abuse laws

Abuse is considered as something done intentionally to hurt the progress of anything. While in this case, Medicare abuse, it’s an intentional act which is done by the ever-experienced practitioners to get benefits. However, as these fraud and abuse cases are recurring from time to time, so the federal government and law forcing agencies have also buckled to counter and decimate these frauds once and for all.

Moreover, these organizations have worked vigorously to devise certain laws to keep these abuses in check. Some of these laws include

  • False Claims Act (FCA)
  • Anti-Kickback Statute (AKS)
  • Physician Self-Referral Law (Stark Law)
  • Social Security Act, which includes the Exclusion Statute and the Civil Monetary Penalties Law (CMPL)
  • The United States Criminal Code

The federal laws governing these Medicare frauds are responsible for specifying all kinds of criminal, administrative, and civil penalties that can be imposed due to these ill activities.

Medicare billing fraud cases

Suppose, a Medicare company bills for a Medicare service that was never provided, it is one of the most criminal ways of conducting the Medicare frauds. Basically, it’s the unlawful billing of the Medicare service. The Medicare billing attorney team is the one that can help to fight these immoral practices.

Some of the most common medical billing frauds are

Double billing

It is a type of fraud of medical billing in which the Medicare service charges twice for any service they provided.

Pharmaceutical frauds

These are one of the most commonly carried out frauds by the Medicare services. In respect to that, there are certain kinds of frauds and abuse they conduct in order to benefit their Medicare service. For maximizing the profits, they can use kickbacks, off-label marketing, and price-fixing. These are some of the most commonly practiced pharmaceutical frauds. For example, if for certain injury opioids should be prescribed but on the contrary an NSAID was prescribed due to immoral kickback accepted by physician to prescribe that drug.

Lack of medical necessity

Sometimes, certain Medicare services aren’t required. However, to benefit themselves sometimes false billing is generated for the services and procedures that weren’t really required at that time.

Phantom billing

It is one of the most commonly practiced abuse in healthcare organizations. It is a kind of billing that’s usually generated for the services and tests that weren’t even conducted in the first place. Moreover, to make things worse they also tempt to bill for employees, who don’t even exist.

What can the Medicare billing attorney team do in this regard?

There’s an experience Medicare billing attorney team. Usually, the team is concerned with all the illegal practices carried at the Medicare services that are related to billing frauds. Similarly, they are well educated about all the legal matters regarding this billing procedures.

If you’ve been ever accused of the Medicare and medical billing frauds, the Medicare billing attorney can come to your rescue. In fact, it’s a battle with the corrupt system that one can’t fight alone so why not opt for a legal team who can guide you all the way through.

Whether you are a sole practitioner or a facility, one is always prone to these medical frauds.

What to look in a Good Attorney?

As we know that the attorney is that legal team that can help you through this process of Medicare billing fraud. However, there are some attributes one should look for in a good attorney, so to work with. Undoubtedly, he’s a professional who’s well equipped in all the aspects of dealing with clients. Moreover, they are skilled incomprehensive counsel to comply with both the state and federal regulations and laws.

Some of the qualities one should look for before going with the team of legal advisors to counsel with them.

  • The attorney should be vastly experienced in healthcare fraud cases. He should be skilled enough and experience to defend its client’s claim and against all types of healthcare fraud lawsuits.
  • Before going for any action and opting for anyone, their reputation should be strictly considered. he must be highly intelligent, skillful, and proactive in his approach. He should be analytical in approach and has rhetorical thinking, who shouldn’t jump into conclusions in the starting. He should have a tactical strategy to deal with all kinds of lawsuits. In a nutshell, he should be experienced and skilled to meet the client’s demands.