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Medicare Fraud Case: Not What Legions Of Providers Want To See

Imagine that you — like virtually all your peers — are a participant within the sprawling American medical industry who merely seeks to go about your job on a daily basis in a conscientious and ethical manner.

You could be a doctor. Alternatively, you might be a nurse, pharmacist, administrator, coding specialist, insurance consultant, billing representative or other employee. There are scores of possibilities.

You work in a complex industry, and you know that.

The health care field is also exacting to a degree flatly unmatched in most other industries, as well. Myriad state and federal regulations permeate virtually every aspect of care delivery and services.

Perhaps that tandem complexity and regulatory accountability is nowhere evidenced more clearly than in the realm of Medicare billings, which are widely perceived in the medical industry as being complicated to an almost bizarre extreme.

In other words, it is easy to make a mistake, even for the most careful and experienced biller.

And when that error is noted, it can lead — and increasingly does these days — to sharply adverse consequences grounded in claims of alleged Medicare abuse and health care fraud.

Such is readily noted by myriad media accounts last week of what is purportedly the largest-ever federal criminal case involving Medicare fraud billings. Reportedly, the indictments brought against several individuals relate to more than $1 billion in false charges and allege wrongdoing on behalf of abetting physicians and other fraud contributors.

The medical field comprises millions of individuals who perform their work ethically and in good faith, and none of those people want to see or be remotely associated with a matter like the above-cited case.

Medicare fraud does exist, of course, given the sheer magnitude of the program.

Just as certainly though, relatively few people engage in fraudulent behavior, with those who do vicariously harming others, who can be unfairly tarnished or even wrongly targeted in criminal probes.

Medical care providers or other industry actors in New York with questions or concerns regarding fraud-based matters or allegations can obtain candid guidance and, when necessary, strong legal representation from a proven health law attorney.


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