• The Gist: Know the fundamentals of Medicare and Medicaid fraud and abuse cases. Providers can be held personally responsible, and can be deemed to have acted fraudulently even when they only “should have known” of the fraud.

By Elizabeth E. Hogue, Esq.

Providers are generally familiar with prohibitions against fraud and abuse in the Medicare and Medicaid programs, including Medicaid waiver programs, and other state and federal healthcare programs. Fraud and abuse in the form of billing for services that were never actually provided to patients, for example, may be especially familiar.

But there are at least two common misconceptions about fraud and abuse…

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