Why Medicaid and Medicare Fraud and Abuse Is A Current issue

Medicaid Planning Attorney

The majority of doctors have strong ethical values and take the necessary steps to avoid fraud by submitting claims properly. Medicare and Medicaid rely on doctors to treat and to bill for services correctly. There are few medical professionals who knowingly run their practices unlawfully. Many physicians, however, violate the billing practices accidentally.

False Claims

Submitting claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent. Filing false claims may result in fines of up to three times the programs’ loss plus $11,000 per claim filed as well as jail time.

Anti-Kickback Statute

The AKS is a criminal statute that prohibits the exchange of anything of value for the people who receive their health insurance through the government.

Fee Sharing

It is illegal for a doctor to be in business with a non-doctor. Thus, any fees charged by a doctor cannot be split with non-doctor, even if this non-doctor invested into the medical facility that the doctor in question occupies.

Fraudulent Billing

If you knew or should have known that the submitted claim was false, then the attempt to collect compensation constitutes a violation.


Upcoding is when a doctor intentionally bills a patient’s insurance agency for a medical procedure that didn’t occur or that costs more than the one performed.

Not Medically Necessary

While most doctors conduct their practice with integrity, many take advantage of the publicly funded program by performing procedures that are not necessary, and do very little to treat the client.

Incorrect Billing Cases:

A psychiatrist was fined $400,000 for misrepresenting the amount of time he provided therapy sessions. A dermatologist had to pay $2.9 million for criminal health care fraud. A cardiologist paid $435,000 due to false claims. An endocrinologist paid $447,000 to settle allegations of upcoding.

People study for years and years to become doctors. However, they frequently end up losing their hard-earned medical licenses or serving jail time simply on accident. With the advice of a health care law attorney, doctors can prevent this from happening.

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