Recently in the news Modern Vascular, a large group of outpatient clinics treating Peripheral Artery Disease (PAD) has been accused of violating the False Claims Act, Medicare fraud. Accusations included the clinic chain offering illegal kickbacks by offering up to 20 doctors the chance to invest in part ownership of the company’s new locations if they would refer their Medicare and TRICARE patients for treatment at Modern Vascular. These “purchased referrals” are said to account for around 90% of Modern Vascular’s revenue. 
The Arizona-based chain of clinics, surgeons, and radiologists that were employed at Modern Vascular was also pressured into increasing the number of serious surgical procedures completed, even setting “aggressive” monthly and weekly goals and in turn, putting their patients at risk by performing unnecessary procedures.
Modern Vascular has “put their own greed over compliance with the law,” the federal complaint states. The company submitted and then received payment for over $50 million in false claims to Medicare Part B and TRICARE.
Other Examples of Medicare Fraud
Medicare fraud is occurring all over the country at an ever-increasing rate. All you need to do is “google” the term Medicare fraud and quickly find list after list of examples of recent fraud schemes. Some involve prescription schemes, others kickback conspiracy, Medicare ID theft and fraud, and more.
A Texas physician pleaded guilty to his part in a $54 million Medicare fraud scheme just a couple of months ago. He got involved by prescribing medical equipment and cancer genetic testing without seeing, speaking to, or treating patients. The doctor’s kickbacks totaled more than $466,000 for these unneeded orders for patients he had never even met. Facing a maximum penalty of 20 years in prison, the federal government is not who you want to mess with. In fact, the Department of Justice reported that healthcare fraud is a major focus for them, and in total, since 1986 – Sept. 30, 2020, they have brought back more than $64 billion of fraudulent, false claims.
One of the most unfortunate parts of Medicare fraud is that it ends up hurting the most vulnerable part of our population. Those who are hurting, looking for pain relief – physical and mental, the older generation, working toward addiction recovery, and more. Medicare fraud also hurts the rest of the population by costing us more in health care costs and taxes across the board.
Medicare Fraud Explained
To give a clear explanation and definition of Medicare fraud – it is when someone purposefully and knowingly deceives Medicare to get paid when they should not. It can also occur when someone gets paid more than they should. Medicare fraud is illegal, and if you recognize it, you are responsible for reporting it.
Medicare fraud may involve one person, several people, clinics, and/or healthcare facilities. It may be the workings of doctors, nurses, patient beneficiaries, or organizations.
Medicare and other healthcare programs and insurance companies rely on providers to treat their patients with their patient’s best interests in mind. Things like incentives for referrals or treatment can corrupt the judgment of medical professionals.
When a provider or facility offers, pays or accepts bribes or kickbacks while treating patients and billing federal health care programs for that treatment, they are giving up the opportunity and privilege to bill those programs.
Examples of Medicare Fraud
An individual or organization is committing fraud if they:
- Bill Medicare for services that the patient never received
- Bill Medicare for visits that never took place
- Bill Medicare for treatment that’s different (and usually more expensive) from how the patient was treated
- Perform treatment or procedures that are not needed simply to charge Medicare for more treatment done.
- Charge Medicare for durable medical equipment that was never used by the patient
- Use someone else’s Medicare information as their own
- Knowingly solicit, receive, offer, and/or give payment to obtain referrals for items or services reimbursed by Medicare.
Medicare Fraud and Abuse Laws
The federal laws that oversee Medicare fraud and abuse are:
- False Claims Act (FCA)
- Physician Self-Referral Law (Stark Law)
- Anti-Kickback Statute (AKS)
- Social Security Act
- United States Criminal Code
All the examples above of Medicare fraud will fit under one of these fraud and abuse laws. These laws also specify what kind of penalties can be imposed on individuals or facilities that commit fraud and abuse the Medicare system. When one of the laws is violated, claims will not be paid, and the abuser will be excluded from all Federal health care programs.
If You Suspect Medicare Fraud
If you spot one of the above examples, first call your provider to ask about the charges so you are sure you understand them. If a billing error is realized in the process, it can be resolved quickly through your provider’s billing office and Medicare.
If you realize that your card has been stolen or someone is using your number for their own treatment, you can call Medicare at 1-800-MEDICARE to report fraud and abuse.
Legal Assistance for Medicare Fraud Defense
Medical professionals jump through many hoops throughout the day while treating patients, all so they can comply with Medicare and other State and Federal healthcare laws and procedures. With so many patients and so many requirements, mistakes can be made, communication errors occur, and suddenly you can find yourself in the middle of a lawsuit with the federal government, all while trying to prove your innocence.
If you do find yourself in the middle of an investigation, you must take it seriously and obtain legal representation immediately. Wormington & Bollinger is an experienced law firm that knows the complexities of the Medicare system and the federal government. If you want representation in a Medicare fraud lawsuit, call our team to learn more about how we can help support you and your case.
We would love to chat about your Medicare fraud lawsuit during a free consultation so that you can feel comfortable and confident in our work and legal plan moving forward. We look forward to meeting you!