Many people use Medicare across the United States, and most claims that come through are valid based on the treatments patients are receiving. But there are times when medical professionals take advantage of the system and file false claims.
Unfortunately, Medicare fraud is an ongoing problem, causing an undue burden on our medical system. In fact, over 5,4000 defendants have been charged since March 2007, and they have collectively billed more than $27 billion in fraudulent claims to private insurers and federal health care programs.
Case Details: Fraudulent Medicare Claims in Northern Texas
Dr. Daniel Canchola, a doctor in North Texas, was found guilty and sentenced for his involvement in a Medicare fraud scheme. Over the years, he submitted over $54 million in fraudulent and false claims to Medicare. The beneficiaries listed on the fraudulent claims included people who were targeted through telemarketing campaigns and health fairs.
His sentencing includes 10 years in prison, with one month served in federal prison. Additionally, he was ordered to pay more than $34 million in restitution.
The claims submitted to Medicare included prescriptions for medical equipment and cancer genetic testing, but the patients were never actually treated. Each time Canchola signed a doctor’s order, he received $30 – resulting in more than $466,000 that he collected between August 2018 – April 2019.
In October 2022, he pleaded guilty to the charges he was facing: conspiracy to commit wire fraud.
Financial Strain on the Taxpayers and Medicare Programs
Government programs, such as Medicare and Medicaid, are designed to provide quality healthcare services to citizens in need. These programs are funded by taxpayers, and the financial pressure is a constant challenge because of the increasing costs and demands in the healthcare industry.
When fraudulent claims are filed, it adds to the burden and stress on the system. For example, the $54 million in fraudulent claims that were processed because of Dr. Canchola’s actions is a waste of taxpayer money. These funds could have been used more effectively, providing legitimate healthcare services to people in need.
This case is just one of thousands that have been prosecuted over the years. The long-term effects of fraud are undeniable and can result in serious consequences over time. Fraud can put more burden on the system, which could result in potential cuts in Medicare benefits. Or, taxes will need to be increased to cover the losses from these false claims.
Patients are at Risk When Fraudulent Claims are Filed
Not only is the Medicare system at risk because of fraud, but patients can also be at risk. These false claims strain the Medicare system, which could result in patients receiving inappropriate medical care or inadequate services. While the goal is to ensure that everyone receives quality, accessible care, fraud can get in the way of the services for people who need them most.
One of the biggest issues that can come up is when doctors are prioritizing billing over the needs of the patients. Patient health should always be the top priority, but there are times when doctors are so focused on the billing that they subject patients to unnecessary procedures. Or, Medicare fraud can also result in patients being denied essential treatments because of the fraudulent billing issues.
Is Trust Eroding in the Healthcare System?
Patients need to be able to trust their doctors and have the peace of mind to know that they are receiving the best medical care possible. Issues such as Medicare fraud have a broader implication because the burdened system makes it harder for patients to receive the care that they need. Over time, patients may become more skeptical about whether healthcare providers have honest intentions. Trust is a key factor in ensuring that patients are receiving the care that they need.
As Medicare fraud is an ongoing issue, these repeated cases make the public less confident when they need to seek medical services. This hesitation can cause people to miss out on necessary healthcare services, which can have serious consequences over time.
Even honest doctors face challenges because it can be difficult to regain patient trust after people have lost confidence in the system. When these high-profile Medicare fraud cases are shared with the public, the general population wonders if there are people who can be trusted in the system.
Administrative Burdens are Heavy
Not only is money lost because of the fraudulent claims that are processed, but the costs go beyond the value of the claims. For example, consider how much administrative work went into the processing and handling of the $54 million worth of cases in this situation.
Medicare, healthcare providers, insurance companies, and other agencies are allocating funds to manage the claims, combat fraud, and investigate the situations. These resources divert funding away from the most essential services that are needed – putting even more pressure on administrative costs. As a result, the whole healthcare system is affected because of efficiency issues.
Fraud Increases Insurance Premiums
In addition to the need for higher taxes, these fraudulent cases can also lead to increases in insurance premiums. Insurance companies raise their prices to cover the losses.
So, not only are Medicare recipients affected, but the general public is also impacted. This ripple effect can involve the entire healthcare industry.
FAQ
What is Medicare fraud?
Medicare fraud happens when healthcare providers knowingly submit false claims so they can receive unjustified payments through the Medicare system.
What Are the Consequences for Someone Who Commits Medicare Fraud?
If a person is found guilty of Medicare fraud, they face huge fines and prison time, and they will also lose their medical licenses.
Can Patients Help to Reduce the Risk of Medicare Fraud?
Yes, as a patient, you can do your part by checking your medical statements. If you see any errors or unusual billing activity, make sure to report your suspicions to Medicare authorities.
Legal Services You Can Trust
Whether you are dealing with Medicare fraud or other legal services, the most important thing you can do is hire a trusted attorney for assistance. Our team at Wormington & Bollinger is always here to help. For more information about available services, contact us to schedule a free consultation.