The Health Law Offices of Anthony C. Vitale
Medicare and Medicaid fraud is one of the most serious risks healthcare providers face today. Whether it’s a simple billing error or a larger compliance issue, any mistake can quickly lead to audits, financial penalties, or even criminal charges. That’s why preventing fraud before it happens is key.
Medicare and Medicaid fraud happens when someone knowingly submits false claims or misrepresents facts to receive healthcare payments. But even unintentional errors—like incorrect coding or billing for services not provided—can count as fraud under the law. Examples include upcoding, unbundling, or referring patients in ways that violate federal rules.
According to the Centers for Medicare & Medicaid Services (CMS), common violations include billing for unnecessary services or receiving kickbacks for referrals.
Government agencies like the OIG, DOJ, and HHS actively investigate providers suspected of fraud. The penalties can be steep—ranging from exclusion from federal programs to criminal prosecution.
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