how to become a medicare fraud lawyer

Medicare Fraud Investigator Education Requirements Education requirements depend on the position you apply for, but most employers seek candidates with a minimum of an associate degree. An associate or bachelor's degree in criminal justice, health care administration or health care information management is a big plus.

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How do I become a Medicare fraud investigator?

You'll need to get some basic fraud investigation experience before you'll be hired as a Medicare fraud investigator. This can include working as an accountant who specializes in fraud detection, an insurance adjuster, a criminologist in white-collar-crime detection, a lawyer who specializes in fraud or a fraud investigator for the police.

What is a Medicare fraud?

A provider that charges Medicare twice for a service or item that you only got once. A person who steals your Medicare number or card and uses it to submit fraudulent claims in your name. A company that offers you a Medicare drug plan that Medicare hasn’t approved.

How much money does a health care fraud investigator make?

There's plenty of work for health care fraud investigators to do. The employment website ZipRecruiter reports salaries that range from ​ $22,000 ​ to ​ $115,500 ​, with a typical pay range for Medicare Fraud investigators of ​ $32,000 ​ to ​ $56,000 ​. As with most jobs, various factors can affect earnings, including geographic location.

What do I do if my Medicare card is stolen?

If you suspect that Medicare is being charged for an item or service you didn't get, or your Medicare card or number is stolen, use the contact information below to report suspected fraud or abuse. Provider fraud or abuse in Original Medicare (including a fraudulent claim, or a claim from a provider you didn’t get care from)

What agency fights Medicare fraud?

the Office of the Inspector GeneralHave your Medicare card or Medicare Number and the claim or MSN ready. Contacting the Office of the Inspector General. Visit tips.oig.hhs.gov or call 1-800-HHS-TIPS (1-800-447-8477). TTY users can call 1-800-377-4950.

What are the consequences of Medicare fraud?

It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent. Filing false claims may result in fines of up to three times the programs' loss plus $11,000 per claim filed.

What is Medicare fraud abuse?

Medicare abuse, or Medicare fraud, is a type of healthcare fraud that affects people enrolled in Medicare. The most common type of Medicare abuse is the filing of inaccurate or falsified Medicare claims to increase profits.

Why is Medicare fraud an issue?

There are health care consequences due to Medicare fraud. A beneficiary may later receive improper medical treatment from legitimate providers because of inaccurate medical records that may contain false diagnoses or incorrect lab results.

What is the Red Flags Rule healthcare?

The Red Flags Rule requires that organizations have “reasonable policies and procedures in place” to identify, detect and respond to identity theft “red flags.” The definition of “reasonable” will depend on your practice's specific circumstances or specific experience with medical identity theft as well as the degree ...

What are the civil penalties if a person is found guilty of Medicare fraud?

Furthermore, individuals who have been convicted of Medicare fraud may be ordered to pay fines worth up to $250,000. Professionals who are accused of any of these violations may also face substantial civil fines. The fine for each false claim is $11,000, while the fine for every kickback is $50,000.

How far back can Medicare audit?

Recovery Auditors who choose to review a provider using their Adjusted ADR limit must review under a 6-month look-back period, based on the claim paid date. Recovery Auditors who choose to review a provider using their 0.5% baseline annual ADR limit may review under a 3-year look-back period, per CMS approval.

What factors might be red flags for Medicare fraud?

Some red flags to watch out for include providers that:Offer services “for free” in exchange for your Medicare card number or offer “free” consultations for Medicare patients.Pressure you into buying higher-priced services.Charge Medicare for services or equipment you have not received or aren't entitled to.More items...

What is the penalty for violating the False Claims Act?

The False Claims Act, 31 U.S.C. §§ 3729, provides that anyone who violates the law “is liable to the United States Government for a civil penalty of not less than $5,000 and not more than $10,000, . . . plus 3 times the amount of damages.” But how does that apply in practice?

Who investigates Telefraud?

Indeed, OIG refers to these as “telefraud” schemes, noting “it is important to distinguish those schemes from telehealth fraud.” In contrast to “telefraud” schemes, OIG has studied how telehealth can be an important tool to improve patient access to behavioral health services.

How much Medicare fraud is there every year?

approximately $60 billion annuallyMedicare fraud can be a big business for criminals. Medicare loses approximately $60 billion annually due to fraud, errors, and abuse, though the exact figure is impossible to measure.

Who commits healthcare fraud?

Health care fraud can be committed by medical providers, patients, and others who intentionally deceive the health care system to receive unlawful benefits or payments. The FBI is the primary agency for investigating health care fraud, for both federal and private insurance programs.

What Does a Medicare Fraud Investigator Do?

A Medicare fraud investigator studies cases related to the misuse of health care insurance. Your duties focus on collecting information on instances of suspected fraud. You review health care data and records to look for evidence of fraudulent activity.

How to to Become a Medicare Fraud Investigator

The qualifications you need to become a Medicare fraud investigator include a degree, investigative skills, and knowledge of Medicare rules and regulations. You can start on this career path in several different ways.

Who can become a Medicare fraud whistleblower?

Any healthcare professional with original information about acts of Medicare fraud can become a Medicare fraud whistleblower and potentially receive a large financial reward.

Have information about Medicare fraud? Report Medicare fraud here

Help stop government waste and abuse, become a Medicare fraud whistleblower and get rewarded for your efforts. Our attorneys have significant experience representing healthcare industry whisteblowers. Complete the secure form on this page or call 1-800-581-1790 for a free no obligation consultation with a lawyer.

What Is Medicare Billing Fraud?

Medicare fraud occurs when a healthcare provider gives false information to Medicare. As a result, the provider receives additional compensation beyond what is appropriate. In some cases, this may be as obvious as billing for a service never received.

Examples of Medicare Billing Fraud

Medicare billing fraud can take on many different forms. In each circumstance, fraud always has one thing in common—medical information is being misrepresented and government funds are being misused as a result. Here are a few examples that qualify as Medicare billing fraud:

The Cost of Medicare Billing Fraud

When Medicare billing fraud occurs, government funds set aside for providing healthcare services for individuals over 65, young people with certain disabilities, or end-of-life conditions are improperly used.

What is Medicare Fraud?

Medicare is a federal health insurance program that provides medical benefits including hospital care, nursing home care, certain doctor services, and may help cover prescription costs. There are different monthly plans that have different benefits and premiums. Medicare is available for people who are:

What Qualifies as Medicare Fraud?

Medicare fraud can involve many different forms. Generally, Medicare fraud involves a doctor or health care worker seeking unlawful compensation from Medicare insurance. Some common examples of Medicare fraud include:

Who Investigates Medicare Fraud Cases?

Medicare investigations generally fall under the jurisdiction of the Department of Health and Human Services (HHS), Office of Inspector General (OIG). The OIG handles whistleblower reports and complaints of fraud in the use of HHS programs, including Medicare and Medicaid.

Is Medicare Fraud a Felony?

Health care fraud involving Medicare is a federal felony. It is a crime for whoever knowingly and willfully executes a scheme to defraud any healthcare benefit program. The penalties for a federal government fraud conviction include up to 20 years in federal prison.

Do You Need a Medicare Fraud Lawyer?

A Medicare fraud attorney can provide legal representation in a criminal, civil, or administrative action. Medicare fraud is a criminal offense, with severe penalties, including jail time, fines, and a permanent criminal record. In addition, the defendant may face financial penalties and triple damages if found guilty of government fraud offenses.

Who can be convicted of healthcare fraud?

Any person (including a corporation) who knowingly and willfully executes, or attempts to execute a scheme to defraud any healthcare benefit program, can be convicted of healthcare fraud. Examples include: Medicaid fraud.

What is healthcare fraud?

Healthcare fraud criminal charges are unlike any other criminal charges a corporate or individual client will face. The regulatory scheme for health care in the U.S. is complex, and most criminal defense attorneys have no idea of its nuances. Being a healthcare fraud attorney requires specialized knowledge of health care statutes, ...

How do healthcare fraud cases develop?

First, the charges could come as a referral for investigation from a state, local, or regulatory body, such as the OIG or a Medicare audit.

What is the most important decision anyone accused of healthcare fraud can make?

Deciding whether you or your corporation should cooperate with the government is the single most important decision anyone accused of healthcare fraud can make. After the decision has been made to make a statement to the government, your success at trial will be severely diminished.

How much is the penalty for false claims?

If you are convicted under the False Claims Act, you can receive a prison sentence up to life in prison, and a fine of $250,000. However, the penalties for healthcare fraud vary depending on the statute charged and the dollar value of the loss to the government as well as a number of case specific factors.

What is a complaint in health care fraud?

A complaint is essentially an affidavit drafted by a law enforcement officer (FBI, DEA, or OIG) and filed with the court.

Can a drug buy back be civilly convicted?

Prescription drug buy-backs. Healthcare fraud can be pursued civilly as a violation of the False Claims Act (31 U.S.C. §§ 3729-3733), or criminally as a violation of 18 U.S.C. §1347 and §1349 (Health Care Fraud and Conspiracy to Commit Health Care Fraud).