MEDICARE FRAUD

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Types of Medical Fraud

"Phantom Billing" - Billing for tests not performed.

Performing inappropriate or unnecessary procedures.

Charging for equipment/supplies never ordered.

Billing Medicare/Medicaid for new equipment but providing the patient used equipment.
Billing Medicare/Medicaid for expensive equipment but providing the patient cheap equipment.

A drug or equipment supplier completing a Certificate of Medical Necessity (CMN) instead of the physician.

"Reflex testing" - Automatically running a test whenever the results of some other test fall within a certain range, even though the reflex test was not requested by a physician.

"Defective Testing" - When a test or part of a test was not performed because of technical trouble (ie: insufficient or destroyed sample, machine malfunction) but is billed for anyway.

"Code Jamming" - Laboratories inserting or "jamming" fake diagnosis codes to get Medicare/Medicaid coverage. Offering free services of supplies in exchange for your Medicare or Medicaid number.

"Unbundling" - Using two or more Current Procedural Terminology ("CPT") billing codes instead of one inclusive code for a defined panel where rules and regulations require "bundling" of such claims. Submitting multiple bills in order to obtain a higher reimbursement for tests and services that were performed within a specified time period and which should have been submitted as a single bill.

"Double Billing" - charging more than once for the same service, for example by billing using an individual code and again as part of an automated or bundled sets of tests.

"Up Coding" - Inflating bills by using diagnosis billing codes that indicate the patient experienced medical complications and/or needed more expensive treatments. (eg., billing for complex services when only simple services were performed, billing for brand-named drugs when generic drugs were provided, listing treatment as having been for a more complicated diagnosis than was actually the case.)

"Phantom Employees" - Expensing employees or hours worked that do not exist.

"Improper Cost Reports" - Submitting false cost reports seeking higher Medicare reimbursements than permitted by actual facts.

Providing Substandard nursing home care and seeking Medicare reimbursement.

Routinely waiving patient co-payments.

Contact our New York Criminal Defense Lawyers today at 914.393.9450

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Copyright Stewart Orden 2012