Billing fraud is arguably the most common type of Medicare or Medicaid fraud. Billing fraud is not necessarily committed by one single person, but is rather committed by several people who are involved in the scheme, all of whom may be criminally charged. For example, you might bill for services that were never rendered, either by entering genuine patient information, or through means of identity theft, including real claims with false information, or simply by entering completely false claims altogether.
Ping-ponging refers to the act of sending a patient for unnecessary tests, or referring them to specialists unnecessarily so that all may bill Medicare or Medicaid. Usually, this occurs when multiple people are committing the fraud together, and is a very serious problem. This not only complicates and worries the patient, but can create a complicated billing trail for investigators to follow.
In many cases, services are bundled and charged together for a lower rate. For example, you might bundle several panels of blood work into one charge. But, if you un-bundle these charges and instead charge line-by-line, you might be paid more by Medicare and Medicaid. This can leave fewer funds to cover the actual problem and diagnosis.
Medicare and Medicaid pay varied rates depending on patient diagnosis information. Therefore, it is important that only accurate diagnosis information is entered. For example, if a nursing home has entered that a patient is completely dependent for all Activities of Daily Life (ADLs), the nursing home will be entitled to a higher rate of payment because a higher level of care is needed. However, if the patient is not actually totally dependent for ADLs, the nursing home might still say they are and pocket the additional money. In a more serious case, patient diagnosis forms that have been falsified might lead later to unnecessary surgeries and procedures, and even death.
If you’ve been accused of committing, or taking part in conspiracy to commit, Medicare or Medicaid fraud, these are serious charges. You will need the top legal minds in your corner, criminal lawyers in Tampa with The Rickman Law Firm can help. The skilled legal team at The Rickman Law Firm will help you understand the best defense for your specific case and will be able to pursue all necessary evidence and witnesses to obtain a favorable outcome.
Your reputation is at stake when you are accused of fraud of any type. Contact The Rickman Firm today to protect your rights and your reputation.