Medical fraud activities have always been a threat to the US healthcare system. Medical representatives such as doctors, nurses, and laboratory workers have been threatened through force and intimidation. Fraudsters have been strategic in obtaining medical-related information. They can work by an individual or collective force.
Today medical fraud activities affect the lives of many. Children, the elderly, and young professionals with high incomes are targets.
Did you know?
In the United States, it is estimated that Medicare Fraud costs about $68 billion annually, (about 3% of the nation’s $2.26 trillion in health care spending).
You can be a potential victim of medical fraud. Prevention is better than panic.
In this article, we are going to talk about the top 5 benefits of hiring a medical fraud lawyer.
Table of Contents
What is Medical Fraud?
Medical Fraud is synonymous with Health Care Fraud. As defined, it is a crime where a fraudster commits a deliberate submission on false or misleading information for personal interest.
What are the common types of Medical Fraud?
Medical Fraud has multiple facets. It includes, but not limited to kickback schemes, self-referral, doctor shopping, identity fraud, layering, upcoding and unbundling, submitting double bills, and billings for services not provided.
Among all medical fraud activities, Kickback schemes, Self-Referral, and Medical Identity Theft are the most common types that a fraudster commits.
Kickbacks are undisclosed payments made by a third-party to a company’s employees. In other words, it involves collusion between employees and vendors. This corruption scheme involves a vendor to submit an inflated invoice to the targeted organization.
An employee of that organization assists in ensuring the false invoice gets into their system. This results in a kickback scheme – it either overstates the cost of actual goods and services or overstates the number of goods sold or delivered.
Referral marketing fraud takes place when a buyer attempts to leverage the current offering by trying to hack the process to get numerous incentives. Under such a fraudulent scheme is the Self-Referral fraud.
Self-Referral fraud aims to get the rewards an advocate receives and the rewards of a referred customer through creating fake accounts and identity theft.
An example is a scammer tries to refer themselves to earn discounts without actually making a purchase.
Medical Identity Theft
Medical identity theft occurs when someone steals your personal information and uses it to obtain medical services, treatment or drugs. The goal of identity theft is to obtain personal information to take advantage of fraudulent billing insurance on providers or government programs for medical goods that are never provided.
Identity theft focuses on obtaining some essential personal information to be used for verification purposes such as Social Security number (SSN), full legal name, date of birth, or the personally identifiable information (PII), including healthcare, medical data, and prescription history.
How can Medical Fraud be committed?
Medical Fraud can be committed either by an individual or by a healthcare provider depending on the circumstances.
On an individual level, allowing someone to use his healthcare identity and insurance information to obtain health services through benefits to pay for unnecessary prescriptions can lead to Medical Fraud.
On a health care provider level, billing services, procedures, or supplies that were never rendered, charging more expensive services, procedures, or supplies than those provided, and misrepresenting non-covered treatments in falsifying a patient’s diagnosis result in Medical Fraud.
What are some landmark cases of Medical Fraud?
Some of these landmark cases have embarked on legal awareness of the fraudulent schemes that could happen in the future.
A Medicare Fraud Case of Starsky D. Bomer (Illegal Kickbacks and Conspiracy to Commit Health Care Fraud)
October 9, 2018, Starksy D. Bomer was prosecuted for a conspiracy to commit health care fraud and receive kickbacks. Bomer orchestrated a scheme where he paid illegal bribes and kickbacks to group homeowners and patients.
Together with the hospitals’ chief financial officer and chief operating officer, Bomer used bribes and kickbacks as salary and transportation payments to group home owners in exchange for patient referrals.
A Case Involving Telemedicine and Durable Medical Equipment Marketing Executives Results in Charges against 24 Individuals Responsible for Over $1.2 Billion in Losses
On the other hand, the case of a Telemedicine and Durable Medical Equipment Executives exposed a unique fraudulent scheme. This company was prosecuted on April 9th, 2019, with health care fraud schemes involving more than $1.2 billion in a loss.
In this case, the telemarketing call center networks in the Philippines and some Latin American countries have targeted elderly and disabled patients on their covered health care services.
Defendants, through these call centers, advertised to Medicare beneficiaries and “up-sold” the beneficiaries to get them to accept numerous “free or low-cost” DME braces, which are fraudulently billed Medicare.
A Medicare Fraud Case of Jorge Zamora-Quezada (False Diagnoses, Illegal Kickbacks, Conspiracy to Obstruct Justice)
Jorge Zamora-Quezada, M.D., 63, a resident of Mission, Texas, and a Texas Rheumatologist, was found guilty for his role in Medicare fraudulent activities in which he falsely diagnosed patients with rheumatoid arthritis.
As a result of the false diagnoses, targeted patients as young as 13 have suffered physical and psychological trauma.
In cases of Medical Fraud, where can I ask legal assistance?
The counsels of Khouri Law deliver quality legal services, making sure that clients are always in good hands.
Medical Fraud Lawyers in Khouri Law have proven experiences in negotiating corporate agreements and are experts in the medico-legal field. They have developed and integrated compliance programs covering all fraud and abuse activities in all kinds of healthcare providers in every aspect of Medicare and other related program audits, investigations and litigation.
In Khouri Law, our Medical Fraud attorneys offer you the best health care litigation, ensuring a well-rounded and holistic legal service across the globe.
Khouri Law Firm defends criminal investigations and defends against professional license disciplinary matters. Our firm understands the relationship between all these moving parts.
5 Benefits of Hiring a Medical Fraud Lawyer
Filing a lawsuit may allow you to hold an individual or a health care provider liable and provide compensation for the medical expenses and other damages.
#1 A Medical Fraud Lawyer Has an Experience and Proven Results
A Medical Fraud lawyer focuses primarily on healthcare fraudulent cases. They are not merely former prosecutors with the familiarity of criminal statutes.
As such, you should hire a Medical Fraud lawyer since he has a solid background in complex Medicare and Medicaid reimbursement regulations including Stark and Anti-Kickback Statute matters.
#2 A Medical Fraud Lawyer Knows a Local Court System
One of the biggest benefits of a Medical Fraud attorney is their knowledge of the local court system.
A Medical Fraud lawyer knows the right people – the judge, prosecutors, court of clerks and everyone involved in the legal process. His local connections form a pattern of persuasion from one judge to another and deliver a strong reputation in his legal profession.
Nevertheless, a Medical Fraud lawyer is favorable to a non-local because of his great access and convenience in giving legal consultation.
#3 A Medical Fraud Lawyer is Devoted to Your Side
Whether you have experienced physical, financial or even emotional loss, a Medical Fraud Lawyer never surrenders and always be devoted to your side in the litigation process.
A Medical Fraud lawyer checks your professional background, past experiences, and related activities in connection with the case. As he aims to win the case, he also wants to build a professional relationship with you.
Hence, a Medical Fraud lawyer stands together with you in all levels of the legal processes. He never surrenders until a judge is persuaded.
#4 A Medical Fraud Lawyer Works With Diligence and Upholds Discretion
A Medical Fraud lawyer knows how to avoid dismissal and lose litigation by ensuring proper filing of documents and timely delivery of pleadings and motions before their deadlines.
They also uphold discretion through practicing data privacy and are responsible for the outright maintenance of your personal information and the details of your case.
#5 A Medical Fraud Lawyer Are Good Negotiators
While everyone pictures a court hearing as a rivalry between two heated parties, a Medical Fraud lawyer ensures to mediate and negotiate for a cost-effective and work-efficient litigation.
A Medical Fraud lawyer studies the behavior of the case. He analyzes before he speaks, and never dismisses the opportunity of negotiating before the actual litigation. In other words, a Medical Fraud lawyer communicates to settle.
Skilled negotiators have the best chance of making things go your way.
To recap, Medical Fraud takes place when a fraudster commits a deliberate submission on false or misleading information for personal interest.
A Medical Fraud Lawyer plays as an expert both in the legal and medical fields. He is not only a dedicated litigator in preparing and filing court documents on time but also takes time in negotiating with the utmost respect in the aim of settlement.
Above all, a Medical Fraud lawyer is a friend who aims to win the case and stands together with you in all levels of the legal processes.
Thus, you need to hire a Medical Fraud Lawyer to obtain these five benefits:
1. A Medical Fraud Lawyer Has an Experience and Proven Results
2. A Medical Fraud Lawyer Knows a Local Court System
3. A Medical Fraud Lawyer is Devoted to Your Side
4. A Medical Fraud Lawyer Works With Diligence and Upholds Discretion
5. A Medical Fraud Lawyer Are Good Negotiators
Khouri Law is ready to assist in quality healthcare litigation and makes sure you are always in good hands.
With proven experiences in negotiating corporate agreements and medico-legal fields, the medical fraud attorneys of Khouri Law are here for you.
Prevention is better than panic. Call us today.