Charged with Medicare Fraud?

Federal Charges for Presenting False Medicare Claims

Medicare is a national insurance program that is administered by the U.S. federal government, it guarantees access the health insurance for Americans aged 65 and older and for younger Americans with disabilities. Medicare fraud is a general term that refers to when an individual or a corporation seeks to collect Medicare health care reimbursement under false pretenses. The goal of Medicare fraud is to collect money from the Medicare program by illegitimate means.

Medicare fraud typically involves phantom billing, patient billing (where the patient provides his or her patient number in exchange for kickbacks), or an upcoding scheme and unbundling (where bills are inflated using a billing code that indicates the patient needs expensive procedures).

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Medicare Fraud & Abuse Penalties

Under Section 1128A of the Social Security Act [U.S.C §1320a-7a(a)], health care professionals (organizations, agencies, or other entities) are prohibited from presenting claims for services that the individual or entity knew or should have known were not provided as claimed, including any person who engages in a pattern of presenting an item or service that is based on a code the person knows will result in a higher payment than the code the person knew was applicable for the actual service provided.

Health care professionals and entities are prohibited from presenting a claim for a medical service that is false or fraudulent, or for filing a claim for a service that was not medically necessary. The fines under this Section can be severe; for example, any physician who knowingly accepts an overpayment and fails to report and return the overpayment is subject to civil penalties of up to $10,000 for each item or service or, in cases in some cases up to $50,000 for each false record or statement or misrepresentation of material fact.

According to the American Medical Association, those individuals who are convicted of a program-related crime or a felony offense related to health care fraud must be excluded from Medicare for a minimum of 5 years, and if there is one prior conviction, the exclusion is for 10 years, and with two prior convictions the exclusion is permanent. However, with misdemeanor health care fraud offenses exclusion is discretionary.

Get the aggressive defense you need; call Joel DeFabio today!

If you are a physician facing Medicare fraud charges, you cannot afford to forgo a strong defense. We urge you to contact Attorney Joel DeFabio right away for aggressive legal representation. With 30 years experience handling various forms of health care fraud, we can fight to protect your reputation and your ability to file Medicare claims.

DeFabio, Beckham & Solis, P.A. - Miami Federal Crime Attorney

Located at:
2420 SW 22nd Street (Coral Way)
Miami, FL 33145. View Map

Phone: (305) 290-2109
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