The Offices of Medicare and Medicaid Management reviews recipient utilization and investigates other charges of fraudulent behavior in order to take action against them.

As health care becomes an increasingly prevalent concern, more lawsuits are filed against health care providers. Meanwhile, laws pertaining to such lawsuits are constantly changing. Any health care provider accused of fraud must hire the best defense attorneys available or risk losing their business to spurious charges.

The federal government is vigilant in trying to catch institutions trying to bill for services not rendered, creating fraudulent cost reports, making kickbacks or self-referrals, etc. They frequently assemble thorough, well-researched health care fraud cases. You need an attorney with a proven record of success defeating federal charges.

Medicaid/Medicare Provider (Medical Office) Fraud

• Billing for services that were not provided, e.g., a chest x-ray that was not taken.
• Duplicate billing which occurs when a provider bills Medicaid and also bills private insurance and/or the recipient.
• Requiring the recipient to return to the office for more visits when another appointment is not necessary.
• Taking unnecessary x-rays, blood work, etc.
• Upcoding, e.g., providing a simple office visit and billing for a comprehensive visit.
• Having an unlicensed person perform services that only a licensed professional should render, and bills as if the professional provided the service.
• Billing for more time than actually provided, i.e., counseling, anesthesia, etc.
• Billing for an office visit when there was none, or adding additional family members' names to bills.
• Accepting payment from another provider, including sharing in the reimbursement paid by the Medicaid program, as a result of referring a patient to the other provider.

 

A Medicaid recipient may be medicaid fraud investigation as well as criminal charges due to any of the following:

• Stating false facts on the application to receive medicaid despite being ineligible;
• Loaning Medicaid to another person;
• Forging or altering a prescription or fiscal order;
• Using multiple Medicaid cards;
• Intentionally receiving duplicative, excessive, contraindicated or conflicting health care services or supplies; and
• Re-selling items provided by the Medicaid program.

 

Mr. Kuniansky has successfully represented clients in a number of Medicare and Medicaid fraud cases across the country. If you have been charged with fraud, you need an attorney who is proficient in federal drug law. Trust our experience: these are serious charges that require active and immediate attention. Call us at 713.622.8333 today

 

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