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» Medicare Fraud

In the U.S., Medicare fraud is a general term that refers to an individual or corporation that seeks to collect Medicare health care reimbursement under false pretenses.

There are many different types of Medicare fraud, all of which have the same goal: To bilk money from the Medicare program. The general scam is believed to have started in South Florida; specifically, Miami-Dade County.

The Medicare program is a target for fraud because it is based on the “honor system” of billing. It was originally set-up to help honest doctors who helped the needy with medical services. There are few safeguards to eliminate false claims. In fact, claims are paid automatically because the goal of Medicare is not to root out false claims, but to pay claims quickly and smoothly.

Types of Medicare Fraud

Medicare fraud is typically seen in the following ways:

(1)		Phantom Billing: The medical provider bills Medicare for unnecessary procedures, or procedures that are never performed; for unnecessary medical tests or tests never performed; for unnecessary equipment that is billed as new but is, in fact, used.
(2)		Patient Billing: A patient who is in on the scam provides his or her Medicare number in exchange for kickbacks. The provider bills Medicare for any reason and the patient is told to admit that he or she indeed received the medical treatment.
(3)		Upcoding scheme and unbundling: Inflating bills by using a billing code that indicates the patient needs expensive procedures.

Durable Medical Equipment (DME) is particularly susceptible to Medicare fraud. DME is used to describe any medical equipment used in the home to aid in a better quality of living. Examples include wheelchairs or oxygen tents.

Recent Medicare fraud, however, focuses not on DME but on HIV/AIDS infusion injections. These injections are very expensive and can sometimes cost hundreds or thousands of dollars per injection. Patients are recruited to receive these injections but are actually injected with saline solution or some other common liquid. Medicare is billed as if the expensive injection was actually given.

South Florida
The South Florida area has become the epicenter of Medicare fraud in the U.S. Miami-Dade County billed Medicare six times more for home health services than Los Angeles County, where the Medicare population is three times larger. In 2005, 72% of all Medicare claims nationwide for HIV/AIDS infusion injections were billed in Miami-Dade County.

Protect Your Rights
If you or someone you know has been accused of Medicare fraud, contact Miami criminal lawyer Robert E. Abreu for a free consultation in either English or Spanish.

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