Medicare/medicaid Billing Fraud: False Certifications and Information

Physicians, hospitals, and other healthcare providers are required to provide a number of certifications when they submit bills to government healthcare programs, such as Medicare and Medicaid. These certifications cover a number of areas, but generally fall into the following categories:  medical necessity – i.e., the services were medically necessary, actual performance – i.e., the services were actually performed, and regulatory compliance – i.e., the services were performed in accordance with all applicable rules and regulations.  Additionally, healthcare companies, such as pharmaceutical companies, device manufacturers, and pharmacy benefits managers, which provide products or services to government healthcare programs, such as Medicare and Medicaid, are required to certify that they are satisfying all obligations under their contracts with the government.

When healthcare providers, manufacturers or vendors falsify required certifications in order to get a healthcare claim paid or to obtain additional business, liability under the False Claims Act or similar state statute will attach.

If you know or suspect that a healthcare provider, manufacturer or vendor is falsifying records in order to meet or continue to meet the conditions of participation in a government healthcare program, such as Medicare and Medicaid, please contact Michael S. Bigin or Laurence J. Hasson.