Kansas Health Care Professionals: Protect Your License, and Beware of Medicare & Medicaid Fraud

Open the newspaper or turn on the television and you are sure to see a story about the widespread prevalence of Medicare and Medicaid fraud by health care professionals. As a result, the United States Department of Justice has made it a top priority to track down those health care professionals who have engaged in such fraudulent practices. In July, a Miami psychiatrist and six other therapists were arrested on charges that they schemed and defrauded over $60 million dollars from the Medicare program. Medicare and Medicaid fraud is not only a federal crime, it can also cost a health care professional his or her professional license. One way to protect yourself and your license is to be vigilant. The following are some of the most common Medicare/Medicaid fraud schemes plaguing health care professionals:

  1. Upcoding: Upcoding refers to a practice where heath care professionals bill Medicare/Medicaid for services or treatments that are covered by Medicare/Medicaid that the patient did not receive, in place of billing for the actual service or treatment that the patient did receive, which is not covered by Medicare/Medicaid.
  2. Waving Copayments: Another way health care professionals have defrauded Medicare/Medicaid is to waive the regular copayment for patients regardless of whether the patient meets the income requirements to do so. Once the copayment is waived the health care provider may also try to suggest treatments or tests to the patient that are unnecessary, but that the patient may go along with, since the test would be free.
  3. Increased Billing Rates for Medicare/Medicaid Patients: A simple Medicare/Medicaid fraud scheme is when Medicare/Medicaid patients are billed more for the exact same services, tests, treatments, etc. than a non-Medicare/Medicaid patient.
  4. Unbundling: Unbundling refers to a fraudulent billing practice where a Medicare/Medicaid patient is not charged once for the entire procedure, for example, a hysterectomy, but rather billed individually for the component services and procedures that comprise the surgery separately.
  5. Billing Medicare/Medicaid for DME Patient Never Received: DME or durable medical equipment refers to any medical equipment that a patient requires for his or her medical condition. DME includes wheelchairs, nebulizers, mobility scooters and moveable hospital beds. In this scheme, a health care professional charges for DME that the patient never actually receives. These items can cost upwards of tens of thousands of dollars.
  6. Billing Medicare/Medicare for Services Patient Never Received: This scheme is similar to the previously described scheme except that Medicare/Medicaid is billed for treatments or procedures that the patient did not receive. Typically, these phony charges are “hidden” amongst other charges for legitimate services that the patient actually received.

If you received notice from your licensing board that a complaint has been filed against you, it is imperative that you act quickly in order to protect your license. When you contact the the Sanger Law Office, by calling 785-979-4353, we will schedule a free and completely confidential consultation. At this consultation, the team of professionals at the Sanger Law Office will listen to you and determine the best approach to protect your livelihood and your reputation. The Sanger Law Office takes pride in providing licensees with exceptional legal services.