Are You Under Scrutiny for Medicare Fraud? Save Yourself from Being Accused of It




Medicare is a national social insurance program for senior citizens administered by the United States federal government since 1966.

According to, “Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).” The program was designed with the aim to help people; however, some providers abused it to earn money.

In fact, the Department of Health and Human Services Office of Inspector General participated in the largest healthcare fraud takedown in June 2016 where 300 defendants in 36 judicial districts were charged with running fraudulent schemes involving about $900 million in false billings to Medicare and Medicaid. Therefore, FBI (the primary agency exposing and investigating healthcare fraud) puts every Medicare and Medicaid provider under the scanner to ensure no one gets involved in the fraud.

However, if you feel that you are under scrutiny for Medicare fraud, you need to act fast as the consequences of being accused of it can be harsh. It makes sense to contact an experienced Medicare defense attorney to defend yourself.

According to Dr. Nick Oberheiden, one of the renowned Medicare fraud defense attorneys, Oberheiden, “Health care investigations are on the rise. While some industries are under stricter scrutiny than others, the likelihood that your practice may one day be audited increases proportionately to the government’s constant expansion of its law enforcement actions.” It is, therefore, important to ensure that your business is clear of any underlying healthcare fraud statutes. But before that, let’s understand what Medicare fraud is.

Understanding Medicare Fraud

According to Wikipedia, “Medicare fraud is the claiming of Medicare health care reimbursement to which the claimant is not entitled.” This means a person knowingly submits a false statement or bill to obtain payment from the Federal healthcare program. Medicare fraud can be of many types, some of which are:

It is best to stay away from practices that can create suspicion and bring you under the radar of the FBI. In the next section, we will discuss how you can save yourself from being alleged for Medicare fraud.

Save Yourself from Medicare Fraud Allegations

The Federal government wants you to represent the services you provide accurately. This means you are expected to bill only for services provided and visits that actually took place. Moreover, you are required to report all the information accurately. Any mistake may raise a red flag.

Here is what you need to do to save yourself from allegations of fraud:

1.  Handle Audits Carefully

In order to keep problems at bay, make sure every documentation is thorough and the audits are handled carefully. This means you need to have every detail of the services provided, patients visiting you, and the money you paid and received. In case you have doubts about a service provided or do not have enough information about a specific case, you must inform the government at once. Remember, you will never be accused for under-billing, but overbilling will be considered as a major offense.

2.   Have a Compliance Plan

If you are a large organization employing a number of professionals, then you need to have a compliance plan in place. This plan should be designed to help you detect and eliminate fraudulent activity from your practice or organization. Having a robust compliance plan will help you prove that you had no intention to get involved in fraud, in case you are being alleged of Medicare fraud. Hire an experienced attorney with knowledge of Medicare and Medicare fraud to design the compliance plan. The attorney can also help you defend your case, if you get involved due to someone else misdeeds within your practice or organization.

3.   Investigate Thoroughly

In case, you are accused of Medicare fraud, it is important that you work with your attorney to plan a string defense. Since Medicare fraud cases tend to be document-intensive, you need to collect as much information as you can as evidence. Interview your patients, suppliers, referring physicians, employees, and others to gather the required information. Involve your attorney when interviewing people so that you cover every legal aspect.

4.   Hire an Experienced Attorney

As mentioned above, it is important to involve an experienced attorney from the day you become a Medicare provider. An attorney will keep you updated about healthcare laws and prevent situations that may get you into trouble. All healthcare providers must be aware of the following three federal laws:

An experienced attorney will help you understand and comply with these laws. He/she can detect wrongdoings and help you take the necessary steps to eliminate ongoing unscrupulous activities.


Until a few years ago, the federal government would only take steps against individuals or organization involved in ghost billing, but things have changed drastically over the years. The FBI has become a lot stricter. Even a small mistake can attract attention and get you charged with fraud. Individuals and organization in the healthcare sector must maintain proper documentation and stay away from illegal activities that can land them in hot water.

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Article last time updated on 20.09.2017.

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