Your medical practice and an investigation for Medicare fraud

Perhaps your medical practice has expanded over the years making it more difficult to keep an eye on everything that is going on.

You have recently become aware of an impending investigation for Medicare fraud. What are your next steps in dealing with this crisis?

Understanding Medicare fraud

There are a number of ways to commit Medicare fraud:

• Knowingly submitting false claims to obtain a healthcare payment
• Sending bills to Medicare for appointments that patients did not keep
• Knowingly billing for services more complex than those provided
• Submitting bills for medical services or supplies that were never provided
• Falsifying records to show delivery of items the patient never received

Preparing for an Investigation

It is wise to place a litigation hold on any documents either in hardcopy or electronic format that might relate to the coming investigation. Advise your staff not to discard or shred any information that could be of interest in the case. Otherwise, the court could impose sanctions that could harm your practice. Among the federal laws concerning Medicare fraud are the False Claims Act and the Anti-Kickback Statute. The agencies you might deal with concerning the investigation itself include the Department of Justice, the Centers for Medicare and Medicaid Services and the Department of Health and Human Services.

Seeking help

Medicare fraud exposes you and your practice to possible civil and criminal liability. Seek professional guidance as soon as you become aware that an investigation is imminent. It is never too early to begin building a strong defense strategy. Your integrity, your career in medicine and your freedoms are at stake.