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Medicare Fraud: A Multispecialty Practice

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As a practice manager of a multispecialty practice, I’ve discovered that one of the internists has fraudulently billed Medicare through upcoding practices. Medicare fraud is a serious violation that comes with severe penalties. For instance, a physician paid over $100,000 in restitution to Medicare beneficiaries who he charged an annual fee for services already covered under Medicare (Lovette, 2011). In another incident involving false claim such as upcoding, a doctor was ordered to pay over $66,000 in restitution, sentenced to 5 months in federal prison, 5 months home detention with electronic monitoring, and 3 years of supervised parole upon release (Lovette, 2011). Physicians are held responsible for falsely reported claims. The government...

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