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Medicare fraud – an overview

The country’s taxpayer-funded healthcare plans – Medicare, Medicaid and TRICARE – provide important benefits to our aging citizens, our economically disadvantaged and our combat veterans that is necessary for millions to survive. However, greed coerces many bad actors to commit acts of fraud each year that cost taxpayers billions of dollars and undermine the crucial system. If you have any reason to believe you were used as part of a Medicare fraud scheme, or have any information about one, contact the Cambridge white collar crime experts at Altman & Altman LLP today.

How does Medicare fraud happen?

With a system as large and complex as Medicare, it guarantees that there will be opportunities for morally-bankrupt doctors, nurses, beneficiaries and others in the healthcare field to take advantage of weaknesses in that system. There is an entire branch of the Office of the Inspector General responsible for investigating and rooting our Medicare fraud.

While no case of Medicare fraud can ever be identical, there are certainly common threads between acts of Medicare fraud. Often they involve one or multiple of the following elements:

  • Overbilling for services
  • Billing for services multiple times
  • Fraudulent billing using falsified patient information or information obtained illegally
  • Billing for services never rendered
  • Falsifying medical diagnoses and charging for their treatment
  • Kickback schemes to secure illicit referrals of patients
  • Prescribing unnecessary medication

A recent 2017 bust of a comprehensive Medicare fraud scheme revealed a $1.3 billion operation that spanned 41 federal districts and involved 412 individuals, including 115 medical doctors, nurses and other medical personnel. It was the largest Medicare fraud bust in the country’s history, and revealed a lot about the extent of Medicare fraud in the country.

The gist of this comprehensive scheme, actually, was quite simple. Medical doctors billed Medicare for services that were never rendered, for prescriptions that were never ordered, and individuals paid kickbacks (incentivized bribes) for beneficiary information so that they could be used as “patients” for fraudulent charges to Medicare that never occurred. Get enough people involved in the scheme and it becomes a billion-dollar operation born from a lack of morality and an abundance of greed.

Fraudulent billing to Medicare is not only illegal, it is incredibly unethical, as it drives medical costs up for everybody else as a result and can leave those who have had their information shared unbeknownst to them vulnerable to identify theft and other financial crimes.

What can you do to prevent Medicare fraud?

The best thing you can do to prevent Medicare fraud is to be aware of what services you underwent while in a hospital or care facility and corroborating that with receipts. If you spot services or unexpected charges to you or to Medicare, you may be part of a scheme that is intended to bilk additional money from the government. Even if you personally aren’t charged money above and beyond what you should have been, you should still seek out legal advice about what to do.

There are ways to report suspected Medicare fraud online directly to the Inspector General, but to prepare a solid report you should consult first with an attorney who has knowledge of Medicare fraud. Attorneys at Altman & Altman LLP have over 50 years of experience fighting white collar criminals and holding those who abuse the government’s most vital systems accountable for their dastardly actions.

No healthcare system is perfect, but those who would take advantage of a system for their own personal gain undermine the system as a whole and cause negative consequences for everybody. Prosecuting these individuals who break the law and drive up costs for everyone is the only way to fight back, and no one should have to fight against powerful schemes alone.

If you have any information about a possible Medicare fraud scheme, or feel as though you have been used as part of one and wish to bring it to light, contact us online or call for a free consultation to go over the details of your case today at

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