If you are a doctor, nurse, pharmacist, medical goods provider or other health care provider serving Medicare patients, you need to keep exceptionally accurate and detailed records. Failure to do so could lead to the government filing Medicare fraud charges against you.
As Medicare Advantage explains, the definition of Medicare fraud is the deliberate claiming of Medicare reimbursement to which you are not entitled.
Common types of Medicare fraud
While the types of Medicare fraud are almost endless, common examples include the following:
- Double billing, i.e., billing twice for a service or product you only supplied once
- Phantom billing, i.e., billing for a service you did not actually perform
- Unnecessary services, i.e., performing unnecessary tests and procedures for the sole purpose of obtaining Medicare reimbursement
- Kickbacks, i.e., accepting payment from a medical device supplier or pharmaceutical company in exchange for recommending or prescribing their product
- False price reporting, i.e., submitting inflated price information
- Upcoding, i.e., changing billing codes from the services you actually performed to higher-level services that reimburse greater amounts
- Unbundling, i.e., billing a comprehensive service piecemeal so as to arrive at a higher total
Anti-fraud laws
Numerous anti-fraud laws exist under which you can face criminal prosecution for Medicare fraud, including the following:
- False Claims Act
- Physician Self-Referral Law
- Anti-Kickback Statute
- Criminal Health Care Fraud Statute
Should a judge or jury convict you, your penalty could include a prison sentence of 10 years or longer, a large fine, or both.
Again, the best way you can prevent even the suspicion of Medicare fraud is to keep accurate, detailed records that can be easily verified if the need arises.
