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Medicare Fraud: Concern For Regulators, But For Doctors, Too

Regulators who administer and police medical payment programs (most centrally, Medicare) often — in fact, routinely — speak of the great challenges they confront in identifying and preventing provider-related fraud, as well as punishing transgressors who engage in fraudulent billings and other unlawful activities.

Often, their complaints and diatribes target the sheer size of government programs, the huge amounts of money involved and, generally, the overwhelming complexity of what they daily face.

Certainly, their jobs are difficult and occasionally frustrating. In focusing solely on them, however, it is easy to forget just how challenging it is for many millions of good-faith medical professionals to duly work within a system that can easily suffocate participants with its complexities and myriad demands.

We duly note that on our website at Daniels, Porco & Lusardi, L.L.P., a New York law firm catering to medical industry clients. We note that, with Medicare matters especially, “layers of regulatory and compliance issues [attach] that must be addressed,” with failure to do so often bringing “serious repercussions.”

Medicare is truly a gargantuan-sized program, with its girth and complexity often resulting in regulators’ tasking providers with insuperable compliance-related duties. A recent AARP article citing some comments from a principal at the federal Centers for Medicare & Medicaid Services (the primary Medicare oversight agency), conveys some telling numbers.

To wit: Medicare receives about 4.5 million payment claims each day. It pays out more than $1 billion to providers every day. It is the largest medical payer in the country.

Of course it must have rules and demand compliance. In seeking to prevent fraud, however, it is unquestionable that many ethical and good-faith medical practitioners are occasionally burdened (and excessively so), as well as wrongly targeted in investigatory probes alleging Medicare fraud.

Those people need prompt, aggressive and knowledge legal representation.

Our firm advocates on their behalf. We welcome readers’ close scrutiny of our blog, and their questions regarding any health law matter.

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