Free Consultation 817.338.1877

Medicare and Medicaid Fraud

Medicare and Medicaid Fraud Attorney

As the U.S. population ages, more Americans are expected to use Medicare and Medicaid to meet their healthcare needs. As that increases, the amount of money lost to fraud is expected to rise as well.  The Government has aggressively prosecuted these cases in the past and given this expectation, is posed to continue its aggressive prosecutions.

Medicare is a federal program and Medicaid is a joint federal and state program to provide healthcare. Federal and state laws make it a crime to commit health care fraud. Those involved face possible civil and criminal liability that could lead to imprisonment, fines and penalties.

How Medicare and Medicaid fraud can happen

There is a wide range of ways the Medicare and Medicaid programs can be defrauded, including,

  • Knowingly submitting, or causing to be submitted, false claims or making misrepresentations of fact to obtain a federal health care payment for products or services for which there’s no obligation to pay.
  • Knowingly soliciting, receiving, offering and/or paying money to induce or reward referrals for items or services reimbursed by federal health care programs.
  • Making illegal referrals for certain designated health services.

Fraud schemes can range from a single operation to one involving multiple people and organizations. Examples include,

  • Billing Medicare for appointments patients failed to keep.
  • Knowingly billing for services at a more expensive, higher level of complexity than services actually provided or documented in the medical file.
  • Knowingly charging for services not given, supplies not provided, or both, including falsifying records to show delivery of these items.
  • Paying for referrals of federal health care program beneficiaries.

Those involved in Medicare and Medicaid Fraud could make millions

An estimated $60 billion of American taxpayer money, more than 10% of Medicare’s total budget, was lost to fraud, waste, abuse and improper payments in 2014 according to a report from the Centers for Medicare and Medicaid Services, the federal agency responsible for Medicare, according to ABC News.

Two real world examples of Medicare and Medicaid fraud in Texas are,

  • The medical director of a group of hospice and home healthcare organizations is one of four charged in an indictment filed in U.S. District Court for the Southern District of Texas. Francisco Pena, 82, is also mayor of Rio Bravo, reports McKnight’s Long Term Care News. The total amount estimated to have been involved is $150 million. The U.S. Department of Justice claims Merida Health Care Group billed Medicare for unneeded services and kept patients in hospice care for years to collect more money. Defendants are accused of conspiring to defraud Medicare by using kickbacks and bribes starting in 2009. Pena is also charged with obstructing justice and providing false statements.
  • The owner of a network of five Houston area home health care clinics is serving a forty year sentence in federal prison because of an ongoing scheme involving $17.2 million in fraudulent Medicaid and Medicare billing submitted from 2009 to 2016. The Houston Chronicle reports Godwin Oriakhi pleaded guilty to two counts of conspiracy to commit healthcare fraud and conspiracy to launder the illegal proceeds of his operation. The defendants submitted claims to Medicare and Medicaid for patients who didn’t need or receive the services and paid physicians to create false medical records to show patients had ailments that qualified them for home health services.

What to do if you’re being investigated for or charged with Healthcare Fraud, Medicare or Medicaid Fraud

The short is, hire the best lawyer you can afford, as quickly possible.  As a Martindale Hubble, AV rated attorney (less than 10% nationally receive this distinction), Bruce Beasley has over 25 years of criminal litigation experience, both as a former prosecutor and criminal defense attorney. Licensed in both State and Federal Court, get the best defense possible from a Healthcare Fraud, Medicare and Medicaid Fraud lawyer serving Fort Worth, Texas, the surrounding area, the State of Texas and across the Country.  Attorney Bruce Beasley understands how important it is for our clients to feel comfortable with their attorney, and makes every effort to earn your trust, keeping you informed throughout the process. If you or your company requires criminal representation in a Healthcare Fraud, Medicare Fraud or Medicaid Fraud investigation or case, schedule a free consultation with Bruce Beasley at 817.338.1877, or you may contact the BEASLEY LAW FIRM by filling out our online contact form.