All You Need To Know About Medicare Fraud

What is Medicare Fraud?

Medicare Fraud is defined as the act of knowingly, purposefully, and deliberately misleading the Medicare claims office with the intent to swindle or manipulate finances and funds disbursed as a result of an ailment; fraudulent acts involving Medicare Fraud are typically classified as involving misleading, deceitful, fake, and spurious measures undertakenby an individual; such activity is recognized as the attempt to garner personal profit or gain as result of fraudulent and deceitful presentation of documentation and reporting assumed to be truthful and accurate.

The submission of fraudulent Medicare insurance claims in order to gain monies or funds is considered to be an illegal and an unethical criminal activity.

Legal Jurisdiction of Medicare Fraud

Due to the fact the provision of Medicare is a program sponsored by the Federal Government of the United States, the applicable legal jurisdiction may span a single jurisdiction. While Medicare Fraud is considered to be a criminal act punishable to the fullest extent of the law, the involvement of the Federal Government provides for an even heightened legal jurisdiction; this may result in an indictment involving Medicare Fraud to be tried within the realm of both Criminal Law, as well as Administrative Law:

The realm of Administrative Law - with regard to Medicare Fraud - is the legal specialty regulating the vast expanse of laws, acts, ordinances, and legislation with regard to any and all interactions in which the Federal Government of the United States engages its citizens

The prosecution of Medicare Fraud within the scope of Administrative Law, applicable charges can include the fraud, misrepresentation, falsification of documents, forgery, and larceny – all resulting from the unlawful duplication of documentation or illegal officiating of government-mandated exchanges

Types of Medicare Fraud

Medicare Fraudcan be either exaggerated or fabricated in its respective nature; the intent to defraud Federal Medicare facilities typically retains both implicit and purposeful measures whose violation of the law exists in concert with a violation of implied trust – the following are the 3 primary examples of Medicare Fraud:

Phantom Billing

This type of Medicare Fraud involves the fallacious and fraudulent reporting of procedures and medical activity allegedly performed with regard to a Medicare claimed that was portrayed to be legitimate; whether or not the procedures reported took place is immaterial – falsifying any official and authorized reporting with regard to Medicare claims is considered to be an example of Medicare Fraud in its fullest degree.

Deceptive Billing

In contrast to Phantom Billing, Medicare Fraud in the form of Deceptive Billing rarely involves a procedure taking place; conversely, a patient involved in this particular type of Medicare Fraud will typically sell – or auction – their respective Medicare claim number in order to initially validate claims. Subsequent to the initial claims, falsified and fraudulent additions to the list of treatments are included with regard to the standard procedure of a respective – albeit fraudulent - ailment

Up-coding and Unbundling

This type of Medicare Fraud typically enacts the usage of codes that exist in conjunction with the billing of expensive procedures. Upon the presentation falsified Medicare claims through the usage of unbundled codes, a Medicare claims office may be swindled into the provision of funds needed for an expensive – albeit fraudulent – Medicare claim

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