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What are common signs of medical fraud?

If you work in a doctor's office, clinic or nursing home, would you know the signs of Medicare fraud if you saw it?

That's an important question because you don't have to be profiting from fraud in order to be implicated in it. Merely being in the office when the fraud happens and being witness to it could put you in a federal prosecutor's scope. The federal government has taken an increasingly aggressive stance against Medicare fraud because of the significant drain it causes on the nation's resources. That has made prosecutors largely unforgiving of people who turn a "blind eye" to an employer's fraud.

Some of the most common methods used to defraud Medicare include:

  • Duplicate billing -- Charging a patient twice for a single procedure, especially for things like steroid injections or other in-office treatments
  • False claims of service -- Billing for medical treatments that were never received at all or billing for tests that were never performed
  • Hidden charges for equipment -- Offering a patient "free" medical equipment that they don't really need and then billing their insurance for it at an inflated rate
  • Accepting kickbacks -- Signing off on equipment or procedures and falsely certifying that they are needed by the patient
  • Falsified records -- Filling out patient charts without actually doing an exam or putting other false information into a chart for administrative purposes

If you're suspicious that your employer is playing loose-and-free with the rules, you need to take steps to protect yourself and your future. You may also be concerned for your professional license (if you have one). Since you don't know where an investigation may lead, it's smart to get experienced legal advice regarding white-collar crimes and Medicare fraud before you decide what to do next.

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