3 common defenses to Medicare fraud

On Behalf of | Jan 27, 2021 | Medicare and Medicaid Fraud

If you face charges for Medicare fraud, you also face serious consequences and penalties. These penalties can include prison time, heavy fines and the requirement to pay restitution.

According to Medicare.gov, Medicare is the federal health insurance program that insures people over the age of 65, some younger people with disabilities and those with End-Stage Renal Disease. Since this program is so expansive, there are several defenses that may help when you defend yourself against charges of healthcare fraud.

1. Insufficient evidence

The government must have enough evidence to show you defrauded the Medicare system. If the prosecution lacks this evidence, they may not be able to continue with your case.

2. Lack of intent

You must have intentionally decided to defraud the medical system or the insurer out of funding to commit fraud. If you made a mistake while still acting in good faith, billed improperly or accidentally left out information, the court may not uphold the Medicare fraud charges against you.

3. Engagement in a compliance program

You may have already developed a compliance program to deter fraudulent activity within your business or practice. If you have evidence of enrollment in one of these programs, it is less likely that the prosecution can argue you intended to commit fraud.

Healthcare fraud can include a variety of actions ranging from falsifying certificates of medical necessity to misrepresenting diagnoses or procedures. These defenses could help you reduce the penalties you face or convince the prosecution to drop the charges against you.


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