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Medicare fraud vs. Medicare abuse

On Behalf of | Apr 22, 2021 | White Collar Crimes |

The Medicare program places a high level of trust in Michigan physicians and their ability to provide a sound medical judgment and treat their patients accordingly. Unfortunately, not all physicians are submitting accurate claims for the types of services that they’re rendering. In fact, Medicare fraud and abuse are becoming growing problems throughout the country.

What is Medicare fraud?

One of the most popular kinds of white collar crimes, Medicare fraud, happens when a person or entity bills for services that were not completed or misrepresents the services that were performed. A common example of this is a physician billing for a complex service to get paid more money when they actually performed a basic service on the patient.

Medicare fraud also includes receiving kickbacks or offering rebates to Medicare patients in order to gain their business. This way, the physician can be reimbursed for services through the federal health care program. Unfortunately, some physicians unknowingly fall for this type of Medicare fraud as they pay for referrals to get new clients.

What is Medicare abuse?

Medicare abuse occurs when a physician or practice indirectly or directly charges the Medicare program for unnecessary costs. This type of abuse typically revolves around a physician offering services above what is determined to be medically necessary so that they can bill the Medicare program for them. Physicians can also commit Medicare abuse if they knowingly charge excessive rates for supplies and services.

The Medicare program is set up to help those with low incomes and those in their elderly years pay for necessary medical services. Unfortunately, some physicians can inadvertently commit Medicare abuse or Medicare fraud. If you’ve been charged with one of these serious crimes, it’s important to seek assistance from an experienced attorney to help fight your case.