The various types of Medicare fraud

| Mar 23, 2021 | Criminal Defense |

Citizens over 65 years old, people with disabilities and those earning a low income can use Medicare in South Carolina to pay for their health care needs. This national health insurance program is administered by the Centers for Medicare and Medicaid Services. While this insurance program is a great way to assist with health care costs, some people do try to defraud the system.

Billing for services never rendered

One of the most common healthcare fraud schemes is to bill Medicare for services that a patient did not receive. It may seem like an easy thing to do with patients whom you’ve seen for years. However, billing Medicare for services that were never rendered is against the law. If you get accused of this violation, you’ll need to seek help from a criminal defense attorney as you’ll likely be fined and required to pay back the money if you are convicted.

Billing for more expensive service than the patient received

Another Medicare fraud scheme that may seem like a quick way to make some extra money is to bill for more expensive services than your patient actually received. Some people refer to this practice as upcoding. This is because the health care professional simply enters a billing code that is for a higher-priced procedure than the one that the patient actually got.

Kickbacks

Kickbacks are commonly referred to as referral credits. These work by one health care provider receiving a set amount of money from another health care provider every time they refer a patient to them. By receiving funds from the other health care provider, the original health care provider is not working in the best interests of the patient. Rather, they’re working to pad their profits.

As the Department of Health continually works to reduce fraud, the above are just some of the many violations that the Department of Health has taken legal action on. If you are accused of fraud, it’s important to seek representation to help you understand your rights.