Medicare/Medicaid Fraud

The United States Department of Health and Human Services (HHS) said in its annual report for the 2014 fiscal year that Medicare and Medicaid together provide health care insurance for one in four Americans. National Health Expenditure (NHE) Data from the U.S. Centers for Medicare & Medicaid Services showed Medicare spending grew 3.6 percent to $672.1 billion in 2016 (or 20 percent of total NHE) and Medicaid spending grew 3.9 percent to $565.5 billion that same year (or 17 percent of total NHE).

The amount of money that is invested in the Medicare and Medicaid programs makes them ripe for fraud, but attempts to procure unauthorized benefits are not limited to patients. Numerous state and federal governmental agencies regularly review records as part of investigations into Medicare or Medicaid fraud committed by providers or insurers.

Lawyer for Medicare/Medicaid Fraud in Tampa, FL

Were you denied Medicare or Medicaid benefits or do you suspect that your healthcare provider or insurer may be engaging in Medicare or Medicaid fraud? Contact Germain Law Group, P.A. as soon as possible.

Tampa insurance attorney Michael B. Germain represents clients in Pasco County, Pinellas County, Brevard County, Hillsborough County, Manatee County, and many other surrounding areas. 

Call (813) 835-8888 to have our lawyer review your case and discuss all of your legal options during a free initial consultation.

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Hillsborough County Medicare/Medicaid Fraud Information Center

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Types of Medicare/Medicaid Fraud in Florida

While a person may be eligible for both Medicare and Medicaid and have both kinds of health care coverages, the two programs are not the same. Medicare is the federal program that provides health coverage to people 65 years of age or older or those who have a severe disability, regardless of income, while Medicaid is the state and federal program that provides health coverage to people with incomes below a certain level.

Medicaid or Medicare fraud costs billions of dollars every year. It is not just governmental agencies that are affected by these types of fraud, as the money that is lost cannot be invested in health care services and typically results in higher premiums for those with health insurance.

Some of the most common ways the health care providers commit Medicare or Medicaid fraud include, but are not limited to:

  • Billing for services not rendered; 
  • Billing a non-covered service as a covered service;
  • Excessive or inappropriate testing;
  • Misrepresenting dates, locations, or providers of services;
  • Incorrect reporting of diagnoses or procedures (includes unbundling); 
  • Kickbacks for patient referrals;
  • Falsifying diagnoses; and
  • Prescribing medicines not medically needed by patients. 

Insurers may also commit fraud by overstating their costs in paying claims, misleading enrollees about benefits, or denying valid claims.

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Medicare/Medicaid Appeals in Hillsborough County

In some cases, people who should be eligible for Medicare or Medicaid health care benefits may be denied coverage. They have the right to appeal these decisions, but the appeals must be filed in accordance with federal rules.

The Agency for Health Care Administration (AHCA) is the state Medicaid agency for Florida. The AHCA is required to issue a written denial notice to an applicant within 90 days if the application was based on a disability or within 45 days on some other basis.

You have the right to be represented by an attorney at a Medicaid or Medicare appeal hearing. Your lawyer may also be able to determine if you are eligible for a different program that provides health care coverage.

Florida Medicare/Medicaid Fraud Resources

AHCA | Medicaid Landing Page — The AHCA is responsible for Medicaid in Florida. Use this website to find where certain types of Medicaid information can be found on the Division of Medicaid’s website. You can also find information about Medicaid finance, analytics, operations, policy, and quality.

Medicare Rights Center — The Medicare Rights Center is a national, nonprofit consumer service organization working “to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives.” On this website, you can access various newsletters, toolkits, checklists, and handouts. You can also find Medicare Interactive (MI), the free and independent online reference tool designed to help people navigate the complex world of health insurance.

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Find a Medicare/Medicaid Fraud Attorney in Tampa, FL

If you think your healthcare provider or insurer might have engaged in Medicare or Medicaid fraud or you were denied Medicare or Medicaid benefits, it will be in your best interest to quickly seek legal representation. Germain Law Group, P.A. represents individuals all over Sarasota County, St. Lucie County, Charlotte County, Hillsborough County, Indian River County, and several other nearby locations.

Michael B. Germain is an experienced insurance lawyer in Tampa who has been recognized as a Florida SuperLawyer for his work fighting insurance companies. He can provide a complete evaluation of your case as soon as you call (813) 835-8888 or submit an online contact form to receive a free, confidential consultation.

This article was last updated on Friday, February 16, 2018.