A new Michigan lawsuit outlines a situation in which a physician in Michigan pleaded guilty to $19 million Medicare fraud conspiracy scheme. The U.S. Department of Justice announced recently announced the defendant’s guilty plea for conspiracy to commit health care fraud.
Michigan Medicare Fraud Conspiracy Case Divulged by Physician Whistleblower
Three Detroit-area providers were involved in the Michigan Medicare fraud conspiracy. According to the physician, he conspired with other physicians and medical providers to prescribe medically unnecessary drugs like hydrocodone, oxycodone, and opana to Medicare beneficiaries.
Many of these Medicare beneficiaries were addicted to narcotics. The providers involved in the conspiracy often required patients to undergo unnecessary facet joint injections before they could receive prescriptions for any controlled substance. While patients were forced to undergo unnecessary procedures, increasing their risks of potential medical complications, the conspiracy participants were racking up fees within the Medicare system.
According to claims outlined in the Justice Department’s Medicare fraud conspiracy paperwork, the Michigan doctor referred Medicare patients to various home health agencies, diagnostic providers, and laboratories, even though the referrals were not medically necessary. The Michigan physician also served as a straw owner of various pain clinics to fraudulently and illegally conceal the true owner’s identity. A straw owner is a person who has the legal appearance of owning a business to hide the identity of the true owner.
The Michigan Medicare fraud conspiracy reached roughly $19 million before the federal government became aware of the Medicare fraud scheme. Medicare fraud conspiracies endanger patients and can lead to criminal charges as well as civil penalties.
What Is Medicare Fraud Conspiracy?
Medicare fraud occurs in situations where physicians or medical providers intentionally perform services that are unnecessary, make intentional errors, or overbill for services in order to receive an inappropriate payment from the government.
Medical professionals involved in a Medicare fraud conspiracy may develop an entire elaborate system in which they attempt to defraud the federal government health care program from a great deal of money. Each year Medicare fraud cost the federal government and taxpayers millions of dollars. Medicare fraud has become more prominent in recent years with the increase in the number of baby boomers who are now eligible for Medicare.
Individuals who become aware of Medicare fraud during their employment may become whistleblowers by providing pertinent information about these charges to the federal government or the authorities. In exchange, whistleblowers receive protection from retaliation from those employers. In some cases, a whistleblower may also receive a share of the amount of money recovered from the defendant. Whistleblowers are often employees of an organization who have access to company documents that prove the company is defrauding the government. Medicare fraud cases have been on the rise recently and the Justice Department has endeavored to zealously pursue these cases.
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