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Understanding Medicare fraud

On Behalf of | Jun 11, 2020 | healthcare fraud | 0 comments

Many people might assume that someone accused of Medicare fraud would have knowingly done something that failed to follow the proper guidelines. That, however, may not always be the case. 

Fraud relating to a Medicare insurance claim may arise from a variety of places and may not always be evident immediately by all parties. 

Prompt review of claim paperwork  

The government’s website,, urges all consumers with Medicare insurance coverage to promptly and thoroughly review all of the statements and claim documentation that they receive regarding their health care. This review should include a corroboration of all service dates and services provided. Any discrepancies should be highlighted and addressed right away. 

The False Claims Act 

Accusations of health care fraud, including Medicare fraud, may fall under the purview of the False Claims Act. The United States Department of Justice explains that this act dates way back to the civil war era. It was originally enacted in response to concerns regarding fraud by defense contractors during the war. Over the years, the FCA’s reach expanded and now applies to many types of fraud involving the federal government. 

If a person or a business files a claim for payment or reimbursement to Medicare and the claim is erroneous or false in any way, the door opens to the potential that allegations of Medicare fraud may result. 

Under the False Claims Act, the federal government may bring allegations against a party and investigate those allegations. Additionally, an individual person may raise allegations of potential Medicare or health care fraud under the False Claims Act. 

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