Georgia Criminal Defense Lawyers Blog
Billing to the United States government presents a unique set of legal requirements for healthcare professionals. Physicians who participate in federal healthcare programs like Medicare and Medicaid are subject to strict billing regulations. Even inadvertent errors can lead to severe legal consequences, including criminal charges. Understanding these laws and the potential risk of noncompliance is crucial for healthcare providers.
When the federal government is paying for items or services rendered to Medicare or Medicaid beneficiaries, federal fraud and abuse laws apply. Healthcare professionals influence what services patients receive and are responsible for the documentation of those services. That documentation is the basis for bills sent to insurers, and ultimately, the Government’s payment of a beneficiary’s medical claims.
If a physician knew or should have known that the submitted claim was false, the attempt to collect unearned money constitutes a violation. Federal fraud and abuse laws include the following: