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Clearwater Criminal Defense Lawyer > Blog > Criminal Defense > Identifying Medicare and Medicaid Fraud Types

Identifying Medicare and Medicaid Fraud Types


Popular government programs that provide healthcare coverage to millions of Americans, Medicare and Medicaid are complex systems. Because of the program’s intricacies, there can be misunderstandings and even outright financial  abuse.

If you have been accused of government program healthcare fraud in the state of Florida, know that it is a serious offense that can carry severe legal consequences. There could be a path to building a robust defense, share your story with a Clearwater criminal defense lawyer to obtain the legal guidance you need.

Understanding Program Basics and Different Fraud Types

While they are both federal health insurance programs, Medicare and Medicaid serve different populations. This is true because each has its own distinct eligibility criteria.

For example, Medicare is primarily for individuals aged 65 and older. The exception to the eligibility age is for younger individuals with disabilities. The program is funded through payroll taxes and allows participants to access hospital services, medical care, and prescription drugs.

Medicaid is not an age-based program, instead it is designed for low-income individuals and families in need of healthcare coverage. Medicaid offers a range of services, including doctor visits and long-term care and is funded jointly by the federal government and individual states.

When a person or group commits Medicare or Medicaid fraud, they typically do so through submitting false information or engaging in deceptive practices in order to obtain undeserved payments. The following are examples of common ways underserved financial gain is pursued.

  • Billing for services that were never provided. When healthcare professionals or their administrative teams build government healthcare programs for services that were never provided to patients, fraud charges could result.
  • Inflating billing codes. Certain codes are used when completing Medicare or Medicaid claims, and it is illegal to use improper billing codes to receive higher reimbursements.
  • Offering or receiving payments for referrals and services. There are kickback restrictions in place for healthcare programs, so offering incentives in exchange for patient referrals or medical services is not permitted.
  • Double billing or unbundling. It is illegal for a provider to charge both Medicare and the patient for the same service, and if there are bundles available, a group of services that are offered at a lower cost, it is fraud to unbundle those services and submit them as separate claims in order to be paid a higher amount.

It is important to note that some government healthcare fraud cases arise from honest mistakes or miscommunications. When it is possible for you to prove that you had no intention of committing fraud, it may be possible to have the charges dropped.

Challenging Evidence and Negotiating Penalties

Whether you need an attorney to scrutinize the prosecution’s evidence to discover the possibility of errors or you want a legal professional to negotiate with a prosecution team in order to have charges or penalties reduced, a Clearwater criminal defense lawyer can help.

Why are you concerned about being charged with healthcare fraud? Share your story with the attorneys at the King Law Group to learn what is possible for your specific situation. Schedule your free consultation.

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