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U.S. Senate Hearing Puts Spotlight on Medicare Fraud Accusations

The Senate Special Committee on Aging held a hearing last week to discuss the prevalence and prevention of Medicare fraud, according to a report by the National Journal. Led by Chairman Bill Nielson, the panel heard testimony from a number of presenters, including a Medicare fraud patient victim, a Medicare program administrative official and a volunteer senior advocate.

In 2012, the federally funded program reportedly lost more than $44 billion, resulting from fraud and mismanagement of funds. Senator Susan Collins commented on this loss, stating that it “undermines our ability to provide needed health care services to the more than 54 million older and disabled Americans.

Considering the increased attention being placed on Medicare and Medicaid, it is likely that more and more providers are at risk of facing criminal charges.

Medicare Fraud in South Florida

According to another report on the hearing, Assistant Special Agent Brian Martens serves in the Miami Medicare enforcement office. He testified about Medicare schemes and how quickly they develop. The agent claimed that perpetrators often move from one scheme to the next, manipulating various aspects of the Medicare system. He said that the offenders are often organized and dangerous. “We regularly encounter stockpiles of weapons when we execute arrests and enforcement operations,” he testified.

South Florida is particularly concentrated with incidents of Medicare fraud, and many local residents are hit with these charges as prosecutors are aggressive in their pursuit of suspects. The area is reportedly ranked third in the number of health care fraud prosecutions nationwide. According to Martens, prosecutions in the region have increased substantially over the last few years, along with a significant decrease in certain Medicare payments, particularly those to community health centers. However, despite the increased enforcement, he reportedly asserted that more resources are necessary to prevent the level of fraud that occurs each day.

What Constitutes Medicare Fraud

Medicare fraud takes on countless forms. It is perpetrated by benefit recipients, healthcare professionals or various service providers. From a recipient standpoint, providing false or misleading information to gain health care benefits is fraudulent behavior. A physician who bills for medically unnecessary procedures is also potentially guilty of Medicare fraud. Home health aid agencies are often targeted by Medicare investigations for inflated service billing.

These are just a few examples of the countless Medicare fraud cases. All of them are extremely serious matters and subject to federal prosecution. It is vital for defendants to secure the representation of a skillful lawyer with vast knowledge of Medicare regulations. Do not forget that being charged with fraud is far different than being convicted, and prosecutors must actually meet their legal burden to prove that misconduct took place.

If you or a loved one has been accused of Medicare fraud, contact Ratzan & Faccidomo. With decades of combined experience, the lawyers of Miami based Ratzan & Faccidomo are skilled in Medicare fraud defense. Call the office today at 305-600-3519 for a confidential and free consultation.


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