Common Types of Medicaid and Medicare Fraud

Sadly we live in a day when some of those that are supposed to be keeping us in health instead take risks with our health for their own personal gain. While most physicians and clinics are free from Medicaid and Medicare fraud, there are many that use patients in order to gain access to these funds, and in doing so risk the health and safety not only of their own patients but also of others who depend on these funds for actual health issues. There are many ways in which Medicare and Medicaid fraud can occur, and knowing how to spot these crimes will help you from falling victim to them.

  1. Billing fraud. Billing fraud is one of the most common abuses of the Medicare/Medicaid system. There are many different scams that are perpetrated. One is billing for services that were never rendered, either by using genuine patient information, identity theft, padding real claims with false information or simply by fabricating entire claims altogether. Billing fraud is rarely committed by one person. All those who knowingly participate in billing fraud can be held liable. Reporting this type of fraud will prevent you from being found financially responsible for the theft.
  2. Falsification of patient diagnosis. Another type of Medicare/Medicaid fraud is the falsification of patient records, including tests and exams, in order to justify surgeries, treatments, procedures or drug regiments. As a patient, nurse or loved one, it is important to carefully check the information you are given to ensure that a proper diagnosis has been given. Falsification of patient records that leads to unnecessary procedures can cause serious damage and even death to these victims. Convincing patients that they have a life threatening condition that must be treated by some medical procedure is both unethical and unlawful and these physicians need to be reported for health care fraud.
  3. Unbundling of procedures. Medical procedures often require multiple steps. Typically, these steps are bundled into one cost instead of being billed separately. Unscrupulous physicians will sometimes have their accountants bill each step separately instead of in a bundle as it is supposed to be. Unbundling means that the doctor or clinic will receive much more money for the service than is deserved, and fewer funds are left over for other work.
  4. Kickback fraud. We have all heard of kickback fraud, but do you know how pervasive it actually is? Pharmaceutical companies wine and dine doctors and clinics, offering substantial kickbacks to those who push their prescription drugs. When these drugs are actually necessary for a real medical condition and result in a bettering of a condition for the patient, then no harm is done. However, all too often physicians write prescriptions for drugs which have absolutely nothing to do with the patients condition simply to take advantage of kickbacks. As well, if patients must return to the doctor month after month for a prescription refill, they profit off the charge of each office visit. Kickback fraud can be dangerous because often the drugs prescribed cause harmful side effects in patients, some even leading to death.

Related articles

Elder Abuse and Medicare Fraud

When it comes to financial matters, senior citizens are vulnerable to exploitation—otherwise known as elder abuse—from family members, friends, neighbors, caregivers and even businesses. More

Read More »

Subscribe to our Newsletter

CONTACT US

for your FREE consultation:

An attorney will evaluate
your claim.

John Morgan
22:48 05 Dec 17
Attorney Ric Barrera took a case for me that two other attorneys turned down. He worked long diligent hours. Put in way above the time and effort for what I paid him. I could always contact him and text him. He got me more than what I asked for in a jury trial where we prevailed against the other party with a unanimous verdict. The jury liked and the case was well presented to them where they understood it. He prevailed over a lawyer who had 40 more years experience than him. I highly recommend him. He is worth every dime of his fee.read more
Marisol Melendez
22:36 29 Nov 17
He is a Great Attorney. I would definitely recommend him for any future civil or law matters. Very Satisfied with his service as a Lawyer.
Ana Davila
16:38 01 Nov 17
I would highly recommend Mr. Barrera! He is a great attorney. He’s very knowledgeable of the statues and law. His rates are very reasonable and will work with your schedule if you need to meet after hours. More importantly, he cares about his clients and will fight for you.read more
Luke Dusterhus
22:02 19 Oct 17
I’ve never seen such dedication in an attorney. He goes the extra mile. I truly believe he’ll be on our voting ballot sometime. Superb! 5 star rating1
East Consequence
14:54 22 Sep 17
I could fill a book describing how unbelievably happy and grateful I am for everything that Mr. Barrera did for me and my family! I am a father living in Huntsville, Texas, 7 hours from the valley and I was a few days away from watching my two beautiful daughters moved out of state by their mother right after their summer vacation with me without being able to do anything about it. I could not find a lawyer in Huntsville that would take my case on short notice, much less even take my phone call and even if they were interested, I could not afford their high fees. Anything that I needed filed would have to be done in the valley so I called 20 different attorneys down south and no one would or wanted to help me. I was ready to give up and accept that as a father the odds were against me and every attorney knew it but I decided to call one more lawyer. When I called Ricardo I was surprised when he was the one that answered the call and at first he sounded very reserved. So I began retelling the same story that I had told all the other attorneys and he immediately took an interest in what I had to say though I was prepared for him to eventually give me the same response that I had become used to. But he didn’t. He quickly assured me that he could help me and would help me and without demanding payment upfront he immediately went to work for me and began the filing process. He was able to help me keep my daughters in my care until our court date but then hurricane Harvey hit the Houston area which deeply affected our area and once again he went to work and got us a continuance because we were unable to travel to the valley. 21 days later we were in the Cameron county for court, and despite having everything against me and her attorney throwing every technicality at the judge to get the case dismissed, Ricardo was prepared for all of it and fought hard for my family. He accomplished something that is very rare in the state of Texas; he won me temporary custody of my daughters! I was prepared for the court to rule against me but because of Mr. Barrera’s unbelievable experience, extraordinary work ethic, and unwavering commitment to my case as well as I carrying himself with a steel confidence that I didn’t even have, I walked out of the court room with custody of my daughters. We still have more hurdles to get over down the line but I have no doubt that Ricardo will approach it with the same determination that he demonstrated for this part of our case and no matter what happens I will be forever grateful for what he has done for me and my family. I said earlier that I could fill a book with my praise but for now let me just conclude with these final words; anyone out there that is on the verge of losing hope and ready to give up, I can say without hesitation and with complete confidence that hope has a name and it’s Ricardo Barrera!D.O. Huntsvilleread more
Claudio Diaz
20:36 21 Sep 17
We found Mr. Barrera on Google reviews when we needed an attorney to handle a case which was down in the Valley. We were quickly given proof that the highly rated reviews were valid. His response time is quick. When he is not available, his secretary is quick to respond and relay messages to him. He is professional and cares about his clients. We trust you will be just as satisfied as our family is when you choose him as your attorney.read more
Rene Martinez
16:08 30 Aug 17
I would highly recommend using Ricardo’s services for any family law case. His knowledge of family law is extremely valuable and helps when you need to talk about the specifics of your case. I was able to come to him with a special child visitation case and he handled it in a timely manner with great success. He eased my concerns stating facts of the law constantly and we received what he asked. His pricing is extremely reasonable, especially for the quality you receive from his office. Ricardo is my lawyer of choice in the RGV area.read more
Mayra Rodriguez
00:32 25 Aug 17
It was a pleasure to have Mr. Barrera as our attorney. I highly recommend him! I was left speech less full of joy and with an open mouth when he won our case!!!! I am beyond great-full and blessed. always had time to see me and answer any questions i had with no hesitation very professional and nice. thank you Mr. Barrera for your time and help.read more
Next Reviews
Call Now ButtonCALL NOW