Medicare Fraud Frequently Asked Questions

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What kinds of Medicare fraud cases can Robins Kaplan LLP handle?

Our firm handles a variety of matters involving fraud against Medicare and other federal healthcare programs. These include matters involving:

  • Kickbacks
  • Upcoding
  • Clinical laboratories
  • Unbundling
  • Services that were never rendered
  • Home healthcare
  • A lack of medical necessity
  • Improper physician self-referrals

What is a Medicare kickback violation?

The Anti-Kickback Statute (AKS) prohibits exchanging anything of value for referrals of services paid for by a federal healthcare program, including Medicare. Anyone who knowingly offers or receives a kickback can be liable under the AKS and, by extension, the False Claims Act.

What is upcoding in Medicare fraud, and how do I identify it?

Upcoding occurs when a healthcare provider submits an inaccurate bill to inflate the reimbursement it will receive. Typically, upcoded bills make use of service codes that are more complex or expensive than the services that the provider actually rendered. Upcoding can be a violation of the False Claims Act because it causes federal healthcare programs to pay more for services than they otherwise would.

What is Medicare home healthcare fraud?

Home healthcare presents many opportunities for fraud because the government pays for home healthcare based on information given to it by the treating providers. As a result, treating providers may have incentives to keep inadequate records or falsely certify a patient’s homebound status.

For a confidential case evaluation, please contact us at 1.888.563.1378 (toll-free), or complete our confidential case evaluation form above. We handle cases in all 50 states.

Jeffrey S. Gleason

Partner

Co-Chair, Health Care Litigation Group;
Member of the Executive Board

Jamie R. Kurtz

Partner

Co-Chair, Health Care Litigation Group

Timothy Q. Purdon

Partner

Co-Chair, American Indian Law and Policy Group;
Co-Chair, Government and Internal Investigations Group

Brendan V. Johnson

Partner

Co-Chair, American Indian Law and Policy Group;
Co-Chair, Government and Internal Investigations Group

Thomas C. Mahlum

Partner

Co-Chair, Health Care Litigation Group

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