Contact Kuniansky & Associates Defense of a Federal Medicare Fraud Case What to do if you are Arrested or Contacted by Law Enforcement |
Most Medicare payment errors are simple mistakes and are not the result of physicians, providers, or suppliers trying to take advantage of the Medicare system. However, there are a few individuals who are intent on abusing or defrauding Medicare, cheating the program (and in some cases the people with Medicare who are liable for co-payments) out of millions of dollars annually.
Types of Medicare Fraud:
- "Phantom Billing" - Billing for tests not performed.
- Performing inappropriate or unnecessary procedures.
- Charging for equipment/supplies never ordered.
- Billing Medicare/Medicaid for new equipment but providing the patient used or less expensive equipment.
- A drug or equipment supplier completing a Certificate of Medical Necessity (CMN) instead of the physician.
- "Reflex testing" - Automatically running a test whenever the results of some other test fall within a certain range, even though the reflex test was not requested by a physician.
- Offering free services or supplies in exchange for your Medicare or Medicaid number.
- "Double Billing" — charging more than once for the same service, for example by billing using an individual code and again as part of an automated or bundled set of tests.
- "Phantom Employees" - Expensing employees or hours worked that do not exist.
- "Improper Cost Reports" — Submitting false cost reports seeking higher Medicare reimbursements than permitted by actual facts.
- Providing substandard nursing home care and seeking Medicare reimbursement.
- Routinely waiving patient co-payments.
Kuniansky & Associates
The Lyric Centre
440 Louisiana , Suite 200
Houston, Texas 77002
Office: 713-622-8333
Fax: 713-224-2815
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