Federal Medicare Fraud

Congress passed legislation relating to the Medicare program in 2010 requiring the use of advanced billing software that is able to flag questionable claims on the front end, preventing payment prior to verification. This was not the case before. Prior to 2010, federal law enforcement officers had no choice but to investigate and seek out suspects after funds were disbursed. When successful, often only a fraction of what was paid out by the government was collected. Ways in which providers defrauded the Medicare system included filing claims for services that were never needed  – or never even provided – while other times duplicate billing was submitted for the same service. If you or someone you know has been charged with Medicare fraud you should contact an experienced Chicago criminal defense attorney right away.

Governing Laws

President Obama’s Affordable Care Act (ACA) sets forth federal penalties to be imposed on defendants charged and convicted with fraud that are tougher than those of the past. This is because the legislation has set aside $350 million in funds over a 10-year time period to battle healthcare fraud. But ACA is not the only law that regulates the industry. Three important federal laws govern medical facilities and professionals. This includes providers of durable medical equipment, physicians (including primary care providers), diagnostic imaging centers, healthcare service groups and ambulatory surgical centers.

  • Federal false claims statute allows a private individual with knowledge of past or present fraud against the government to sue on behalf of it. Civil penalties and damages may be recovered;
  • Federal anti-kickback statute makes it a crime to make payments to reward or induce referrals of federal healthcare services to a company; and
  • Stark Law prohibits a health services provider who has a financial relationship with an entity to refer a Medicare or Medicaid patient to that entity; this extends to a member of the provider’s immediate family; the entity may not request payment for any item or service defined under the law unless they fall under the law’s exceptions.

Requirements set forth under these laws are complex. This is especially so when it comes to medical billing regulations.

Contact a Chicago Criminal Defense Lawyer

If you or someone you know has been charged with Medicare fraud, or any other type of crime, contact a knowledgeable and aggressive Chicago medicare fraud defense attorney today. The defense of a criminal fraud charge can be complicated as government prosecutors have access to an entire legal team to put together a case. Attorney Steven Goldman has decades of experience successfully defending clients in criminal cases. To schedule your initial consultation, contact (773) 484-3131 today.

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