Top Waconia, MN Medicare Fraud Lawyers Near You
Our nationwide team of defense lawyers includes a former U.S. Attorney, four former Federal Prosecutors, two former FBI agents and two former Army JAGS.
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Vigorous criminal defense representation for adults and juveniles. Even a minor criminal charge can change your life forever. Call as soon as you can to learn about your options.
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Fed Trouble? Free Consult. Former Prosecutor & Team Former Federal Agents. Call/Text 24/7. Immediate Response Guaranteed!
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650 Third Avenue South, Suite 260, Minneapolis, MN 55402
When you need legal representation for your Medicare Fraud, connect with William Mauzy, Attorney at Law in Waconia, Minnesota.
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302 N 10th Ave, Minneapolis, MN 55401
In Waconia, Minnesota area, Groshek Law PA can help clients with their Medicare Fraud needs.
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90 S 7th St, Suite 2200, Minneapolis, MN 55402
150 South 5th Street, Suite 1490, Minneapolis, MN 55402
33 South 6th St, Suite 3600, Minneapolis, MN 55402
80 South Eighth Street, Suite 3100, Minneapolis, MN 55402
2640 Eagan Woods Dr, Suite 220, Eagan, MN 55121
7825 Washington Ave South, Suite #220, Bloomington, MN 55439
80 S 8th St, Suite 2800, Minneapolis, MN 55402
609 S. 10th St, Suite 200 A, Minneapolis, MN 55404
1611 County Road B West, Suite 101, Roseville, MN 55113
2200 IDS Center, 80 South Eighth Street, Minneapolis, MN 55402
80 South 8th Street, Minneapolis, MN 55402
125 SE Main St, Suite 339, Minneapolis, MN 55414
225 South Sixth Street, Suite 2800, Minneapolis, MN 55402
3730 Edmund Blvd, Minneapolis, MN 55406
225 South 6th St, Suite 1830, Minneapolis, MN 55402
801 S Marquette Ave, Suite 200, Minneapolis, MN 55402
101 East Fifth Street, Suite 1500, St. Paul, MN 55101
219 Main Street Southeast, St. Anthony Main, Suite 403, Minneapolis, MN 55414
50 South Sixth Street, Suite 2600, Minneapolis, MN 55402
9800 Shelard Pkwy, Ste. 310, Minneapolis, MN 55441
225 South 6th St, Suite 2900, Minneapolis, MN 55402
1229 Tyler St NE, Ste 205, Minneapolis, MN 55413
50 South 6th Street, Suite 1500, Minneapolis, MN 55402
Waconia Medicare Fraud Information
Lead Counsel independently verifies Medicare Fraud attorneys in Waconia and checks their standing with Minnesota bar associations.
Our Verification Process and Criteria
Ample Experience
Attorneys must meet stringent qualifications and prove they practice in the area of law they’re verified in.Good Standing
Be in good standing with their bar associations and maintain a clean disciplinary record.Annual Review
Submit to an annual review to retain their Lead Counsel Verified status.Client Commitment
Pledge to follow the highest quality client service and ethical standards.
What Constitutes Medicare Fraud?
Medicare is a national health insurance program, administered under the Centers for Medicare and Medicaid Services (CMS). Medicare covers many of the healthcare expenses of enrollees. Uncovered services and remaining costs may be covered by private insurance or other government benefit programs. To be eligible under Medicare, the individual has to meet one of the following requirements:
- Age 65 or older and a U.S. citizen, or LPR for 5 continuous years with a qualifying spouse or ex-spouse
- Under 65 with a disability and have been receiving SSDI or other disability benefits for a qualifying period of time
- People with End-Stage Renal Disease (ESRD) receiving continuing dialysis
Medicare fraud involves making false claims or fraudulent misrepresentations for Medicare health care benefit reimbursement. According to the Government Accountability Office, Medicare is vulnerable to fraud, with a low rate of Medicare claim audits. People accused of Medicare fraud can involve anyone involved in government healthcare benefit program, including:
- Doctors and medical providers
- Billing professionals
- Health care professionals
- Health care services companies
- Insurance companies
- Pharmaceutical companies
What Are Examples of Medicare Fraud?
Medicare fraud generally occurs between medical care providers and patients, vendors, or other doctors. There are several examples of medical billing fraud, anti-kickback violations, and financial gain through improper self-referral. Some common examples of Medicare fraud include:
- Billing for services that are not necessary
- Health care provider treatment for an undiagnosed condition
- Charging for an unnecessary expensive service
- Paying kickbacks for referrals
- Unbundling medical procedures
- Double billing or duplicate claims
- Up-coding
- Billing for medical services never provided
How is Medicare Fraud Determined?
There are several ways Medicare fraud can be identified. Suspected fraud can be reported by patients, healthcare providers, or even employees. Health care fraud cases can also be identified through computer analysis. CMS uses a Fraud Prevention System (FPS) to identify possible fraud. According to CMS, the FPS is a “state-of-the-art predictive analytics technology.”
The system assesses all Medicare fee-for-service claims to identify fraudulent claims and take administrative action. When patterns of inappropriate billing are identified, investigators conduct site visits, interview patients, and review medical records to identify fraud.
The Office of Inspector General (OIG) has a hotline for reporting potential fraud and Medicare abuse. Patients, co-workers, or employees may have an incentive for reporting fraudulent billing and may be eligible for whistleblower awards under some federal programs.
Is Medicare Fraud Civil or Criminal?
Medicare fraud charges can involve both civil and criminal laws and penalties. Federal health care fraud carries felony criminal charges. The penalties for a conviction of federal government fraud include up to 10 years in federal prison, or up to 20 if it resulted in serious bodily injury.
When a doctor refers a Medicare patient to another business or provider where the doctor has a financial interest, it may be a violation of the Physician Self-Referral Law, or the Stark Law. Civil penalties for illegal patient referrals include civil penalties, treble damages, and Medicare program exclusion.
The Anti-Kickback Statute is a criminal statute, with penalties including possible imprisonment for up to five years, fines, and exclusion from federal benefit programs.
The False Claims Act (FCA) provides for civil penalties where a doctor defrauds the federal government. The FCA also provides a reward system, and whistleblowers can recover up to 30% of the money recovered by the government.
Other penalties may include restitution, or paying back the victims of fraud. After a conviction for Medicare fraud, a doctor could also lose their medical license or be excluded from participating in Medicare or Medicaid. Medicare fraud may also involve other criminal violations, including:
- Identity theft
- Forgery
- Money laundering
- Wire fraud
- Insurance fraud
What if You Are Accused of Medicare Fraud?
Not all Medicare fraud criminal investigations involve criminal intent. There are a number of possible explanations or legal defenses when a doctor faces fraud allegations. In many cases, suspected fraud may be caused by simple mistakes or unclear rules, without any intention of fraud. A fraud attorney can review your case for a strategic defense, with possible defenses including:
- Accidentally putting in the wrong billing code
- Accidentally ordering extra diagnostic tests
- Billing employees did not have the proper training
- Patient claimed they did not already have a procedure or test
- Misspellings or unclear handwriting