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Bronx Medicare Fraud

In conjunction with fraud carried out against the Children's Health Insurance Program and Medicaid, it is estimated that more than $100 billion in taxpayer money is lost every single year due to health care fraud like Medicare fraud. Consulting with a lawyer may be the only way for you to protect yourself against the significant consequences that apply. Anyone who is accused of Medicare fraud may risk their ability to remain in their profession and be responsible for civil and criminal penalties.

A Medicare fraud defense lawyer in the Bronx is the only way to ensure that you have someone advocating for your best interests. Trying to manage the case on your own without a Bronx Medicare defense lawyer could expose you to significant risks. You need someone who is experienced with legal defense for businesses, entities and individuals under investigation by the federal government because of Medicare fraud allegations. A Bronx Medicare fraud defense attorney will evaluate the strength of the prosecution's case against you and be familiar with all of the common stages of a Medicare fraud lawsuit. While an allegation like this might fall under the umbrella of white collar crime, it should still be taken seriously.

Defining Medicare Fraud

Medicare fraud in itself is a violation of federal law. This can occur when at least one error or mistake is made on a claim filed with the federal health care program. This is why it is so important to have strict compliance programs in place that help decrease the chances of Medicare fraud. Claims can also be filed with Tricare, Medicaid or any federal workers' compensation program. If you have been accused of Medicare fraud already, a Medicare fraud defense attorney in the Bronx can be able to tell you which of the statute or law violations apply:

  • Stark Law
  • The Social Security Act
  • S. Criminal Code
  • False Claims Act
  • Anti-Kickback Statute

There are nine different areas in the nation that are monitored by the Medicare Fraud Strike Force because of the number of residents living in that region who rely on federal health care programs and New York is one of these areas. This means that with the increase in the number of claims filed with federal health care programs, the federal government also believes that the number of Medicare fraud instances will also increase. The Medicare Fraud Strike Force investigates, monitors and prosecutes instances of Medicare fraud and represents numerous federal agencies who work together including the Department of Human Services, the DOJ, the Office of the Inspector General, the DEA, the DOD and the IRS. Other federal agencies may also be involved in your case and this may have been your first clued that you are facing charges of Medicare fraud. The right Medicare fraud defense attorney in the Bronx will be able to tell you the specifics of your case and what evidence is already gathered against you. Some of the most common mistakes involved in Medicare fraud situations include:

  • Upcoding
  • Inflating charges
  • Submitting claims for medically unnecessary supplies
  • Double billing for medical services or equipment
  • Billing for services that were never performed
  • Overusing medical equipment
  • Accepting or providing kickbacks
  • Submitting claims for unnecessary medical certifications, such as for home health care or hospice

The most common businesses across the Bronx that are likely to face a Medicare fraud investigation include pharmacists, physicians, hospitals, nursing homes and nurses. However, any facility, business or person that files claims with the federal health care programs can be charged with Medicare fraud.

There are civil and criminal penalties associated with a conviction including fines, attorney fees, repayment of claims in question, future claims not being paid, assignment of trouble damages and exclusion from health care programs. You may also have a federal prison sentence, fines and a criminal record if you are convicted of criminal charges. You need someone who is familiar with the landscape to protect you in this situation. Any kind of fraud charge, especially in a healthcare situation involving Medicare, must be taken seriously. You simply can’t afford to wait to get help on a Medicaid fraud case because criminal consequences may apply.

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