MIAMI, Florida has been ringing a bell to everyone in the US when we talk about Health care fraud, specifically the medicare fraud scheme where a florida health care executive was sentenced to 20 years in jail for what prosecutors described as a massive $1 billion Medicare fraud scheme. — one of the biggest such cases in U.S. history.
In essence, health care fraud is as in every other industry: fraudsters benefiting unfairly from the means and opportunity. Intra- and out-of-industry healthcare crooks include patients, payers, employers, suppliers, and pharmaceutical companies.
Healthcare Fraud Group Miami has been the leading group to resolve all of these schemes and they also cited the most common fraud provider activities which are draining public finances and promoting unstable care conditions for beneficiaries, specially in Miami.
1. Drug diversion is prescribed.
The recruitment of prescription drugs refers to the practice of putting in one person’s hands’ controlled substances. This can be done in many different ways, at various levels, including from the sale of their medicines to the issuance of false prescriptions. It can also involve the modification of orders to the forging of fictitious Medicare or Medicaid prescriptions to patients.
Furthermore, pharmacists or staff can create false prescriptions at pharmacy levels to cover pill theft. Also, doctors or staff may conspire to issue drug prescriptions with patients that are not medically needed in physician-owned practices.
2. Schemes for drug shortening and refilling.
If a pharmacy prescribes 80 drugs on the 100-pill prescription and bills Medicare or Medicaid for all 100 pills, this is a form of healthcare fraud. The order does not include a single medicine, but the medication also does a different one. The federal government must also be charged for replenishment when, in reality, a patient never comes to a prescribed replacement.
3. Increase and false prescriptions of medicine dispensed.
Medicare or Medicaid must be billed for prescription medicines, which are not medically necessary, as opposed to drug shortening. A provider may prescribe additional medication to send a more massive bill to either the government or insurance company, rather than issuing a prescription solely for drugs that a patient requires.
4. Pharmaceutical fraud compound.
As composite pharmacies have recently reoccurred, we are also witnessing an increase in DEA investigations and the prosecution of the Justice Department (DOJ).
5. False, fraudulent, and illegal selling.
For selling falsified, fraudulent, and illegal prescriptions, many physicians and organizations involved in health care fraud have been prosecuted. For example, if a medicine does not support the need for medication, a doctor may agree to sell a prescription for pain medication or another controlled substance to a patient in exchange for an extra charge.
In other cases, physicians or fraud performers can generate and sell fake prescribers with a legitimate or counterfeit prescription pad in either case to seek Medicare, Medicaid, or a private insurer for further compensation.
6. Importing medicinal products illegally.
It is illegal under U.S. federal law to import into the country from a foreign competence any controlled substance prescribed or unlawful. Doctors, pharmacists, and other providers may attempt to import pharmaceuticals illegally to suit their patients’ needs or to sell falsified prescriptions and may misrepresent the imported pharmaceuticals as internal legal medicine in order to apply to the centers for Medicare and Medicaid (CMS) or another health care provider of the federal or national governments.
7. Medicines prescribed without an in-person examination.
A physician must perform a personal examination first to prescribe medication to a patient. Prescribed medical treatment may be charged as a form of healthcare fraud without a review, or with a cursory test that does not adequately identify the patient’s health condition or drug needs.
8. Inaccurately reporting and falsifying patient records.
In some cases, doctors or other providers may falsify records of patients or report test results to prescribe a non-medically necessary medication inaccurately. The form of healthcare fraud generally pursued by the DEA and other state and federal law enforcement agencies is Billing Medicare, Medicaid, other government-wide benefit programs, and private medical prescription insurers.
9. Kickbacks payment and receipt, including controlled substances prescriptions.
Bribes, kickbacks, referred goods, and other forms of compensation payable out of the federal benefits reimbursements are prohibited under the anti-kickback statute and other federal law. DEA investigation is often confronted by physicists who accept payment in exchange for referrals to pharmacies and compounds, or pharmacists who bribe doctors for prescription or referral of patients.
10. Double accounting, upcoding, and other fraud systems for billing.
Fraud billing schemes and involuntary billing errors often lead to DEA research. Overcharge (filing for more medicines than was dispensed), double-billing (filing twice the same prescribed prescription, either to the corresponding federal agency or insurers or to multiple entities), and other methods for claiming compensation above can all lead to investigations.
With over fifteen years of experience,James S. Bell P.C, of Healthcare Fraud Group Miami. has forged a name as a leading United States trial attorney. Most notably, Bell obtained the largest verdict in the United States in 2017 and the ninth (9th) largest verdict in United States history against JPMorgan Chase Bank for in excess of $6,000,000,000 (6 Billion Dollars).
Bell has become a recognized legal thought leader through projects such as co-authoring an article titled “Piercing the Corporate Veil” regarding property division in divorce and features in publications such as Forbes, Inc., and Entrepreneur and has been granted recognitions such as Best Personal Injury Attorney and Litigator of the Week.
Bell is in admission with the Bar in the States of Texas, California, and New York, and obtained his undergraduate and law degrees from Southern Methodist University. He continues to serve in a wide breadth of cases, including but not limited to healthcare disputes; Qui Tam litigation; white-collar criminal defense; catastrophic injury; ERISA; business fraud; bankruptcy; professional negligence/malpractice; oil & gas; complex securities disputes; divorce; child custody; and real estate fraud cases.