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MEDICARE / MEDICAID FRAUD

Medicare Fraud 

 

In the United States, Medicare fraud is a general term that refers to an individual or corporation that seeks to collect Medicare health care reimbursement under false pretenses. There are many different types of Medicare fraud, all of which have the same goal: to collect money from the Medicare program illegitimately.

 

The total amount of Medicare fraud is difficult to track, because not all fraud is detected and not all suspicious claims turn out to be fraudulent. According to the Office of Management and Budget, Medicare "improper payments" were $47.9 billion in 2010, but some of these payments later turned out to be valid.

 

The Congressional Budget Office estimates that total Medicare spending was $528 billion in 2013. The Medicare program is a target for fraud because it is based on the "honor system" of billing. It was originally set-up to help honest doctors who helped the needy with medical services.

Medicaid Fraud
 

Medicaid is a health care program created to help individuals and families with little resources and low-income pay for their health care costs. Medicaid is also the main source low-income families look to in order to receive funds from for their health care service in the United States. Families and individuals must qualify for Medicaid based off of a means-test and receives its funds through the states and the federal government, but the program is managed by the states. States have wide flexibility to decide who is eligible for the program.

 

Participation in Medicaid is not required of the States, but all States currently do participate.

Medicaid covers low-income adults, their children, and individuals with specific disabilities. They all must all be U.S. citizens or legal residents. Being a low-income individual or family is not the only requirement to qualify for Medicaid. With the implementation of The Patient Protection and Affordable Care Act, eligibility guidelines have expanded and federal funding has been increased as well.

 

In National Federation of Independent Business v. Sebelius, the Supreme Court rules that states don’t have to adhere to the expansions in order to continue to receive their previous amounts of Medicaid funding. Several states, in turn, have decided to maintain the pre Affordable Care Act levels and eligibility criteria. 

When you are charged with a crime, your search for an Orlando Medicaid and Medicare defense attorney is a task of tremendous importance. Contact us today to get the best defense of your rights.