Are You “Accidentally” Committing Medicare Fraud?

Accidental Medicare Fraud

Medicare fraud is a serious topic that affects seniors across the nation and wastes billions of taxpayer dollars every year. When discussing Medicare fraud, many people focus on con artists and scammers who take seniors’ Medicare numbers to use them illegally. But many doctors and other medical practitioners perform Medicare fraud as well, over the course of providing very real services for their work.

“Accidental” Fraud?

The problem is that because of the vagaries of Medicare law, many doctors and their offices may not know that they’re doing anything illegal. You might be running afoul of a law that you didn’t know existed.

The government keeps close track of Medicare billing. If they find you’re billing your Medicare patients in a way that suggests fraud, you may receive a letter from the federal government asking you to surrender some of your billing and treatment records.

The Importance of Legal Counsel

Receiving that kind of communication can be very frightening for medical practitioners and their offices. If you fail to prove to the government’s satisfaction that you haven’t abused Medicare, you might be fined large sums of money, face action from your state’s medical board and even be denied the right to bill Medicare in the future. How can you be sure you avoid that sort of legal nightmare?

Your absolute best practice is to hire a Houston medicare fraud defense attorney as soon as you start taking patients who are on Medicare. This way, you’ll receive special guidance before you start about common pitfalls in billing and other practices. You’ll also have an expert on hand who can review your practices as you go to let you know you’re doing everything above-board.

Common Medicare Mistakes

In lieu of personalized advice, here are several common mistakes practitioners make when providing services to patients on Medicare. As you might imagine, these errors may have a profit motive in mind, or they might be the result of a simple accident.

  • Improper recording of services. Many practitioners may keep incomplete records of services provided to patients. When your patients visit you, keep close track of all services you provide, including in-person care, medication and medical equipment. All these records should be signed (by the practitioner) and dated.
  • Accurately describing all services. Medicare does not cover all medical care your patients can receive. Because of this, it’s important to provide clear and accurate diagnoses in your records, along with a clear explanation of the medical necessity of a given procedure. (Different states have different definitions of medical necessity for different procedures.) Attempting to “fudge” information about what services you provided and why — even if you’re doing so to try to get more services covered, for the good of your patient — is Medicare fraud.
  • Failure to return overpayments. If you accidentally overbill Medicare, or if you receive more money than you’re due from Medicare for any reason, you need to take steps to rectify the situation immediately. Contact Medicare within 60 days to explain the circumstances, and send back the over payment.

If you or your office is accused of Medicare fraud, don’t go it alone. Hiring a good Houston federal defense lawyer to handle your case, as soon as the allegation is made, is vital to coming out on top.

Contact the Houston federal criminal defense lawyer at The Law Offices of Seth Kretzer by calling 713-775-3050 for a health care fraud defense consultation, or contact us online.

Phone: 713-775-3050
Fax: 713-929-2019
Houston, TX 77002
440 Louisiana, Suite 1440