Health care frauds rank as one of the most commonly prosecuted crimes in recent times. The federal false claims act has been effective in recovering billions of dollars on behalf of taxpayers from pharmacies, doctors, hospitals, and pharmaceutical companies. Whenever any fraud concerning health care occurs, it is better to get in touch with the firms offering healthcare fraud investigation in Miami.

1. Healthcare Fraud Investigation
in Miami
Health care frauds rank as one of the most commonly prosecuted crimes in
recent times. The federal false claims act has been effective in recovering billions
of dollars on behalf of taxpayers from pharmacies, doctors, hospitals, and
pharmaceutical companies. Whenever any fraud concerning health care occurs, it
is better to get in touch with the firms offering healthcare fraud investigation in
Miami.

2. Medically Unnecessary Services
• Medicare can only reimburse for the procedures or expenses that are medically
essential. Suppose the patient believes that their doctor suggests procedures or
tests or any other medical process that is unnecessary and minimally related to
their health. In that case, the referral may be medically unnecessary and violate
federal healthcare rules.
• Kickback Schemes
• In the healthcare industry, kickbacks are rampant. It is unlawful and unethical for
any medical facility or doctor to receive any cash or other things of value from
another doctor, pharmaceutical company, healthcare facility, or anyone else. This
might happen if the individual or firm refers patients at a certain rate, meets a
certain quota, or makes any decision that the offering can taint.

3. • Allowing Staff And Nurses To Perform Examinations
There are certain procedures that a physician can only perform. Nowadays, it is an
emerging trend to allow the nurses or office staff to handle routine outpatient
procedures while billing the government for the cost of doctor’s time. This does
not only come under a false claim but also invites real-life danger to the patients. If
an inexperienced or undertrained staff member conducts a complex medical
procedure, it might cause severe risks.
• Failure To Properly Charge Medicare And Medicaid Patients
This kind of activity causes a violation of program rules and can result in a
successful False Claims Act against the pharmacy. The pharmacy has to charge
Medicare and Medicaid patients fair market value for the drugs, equal to the
amount charged to other customers.

5. • Upcoding
When the upcoding is illegal, it costs the federal government millions of dollars per
case and can be easily detected by thoroughly reviewing the bill. If there are
suspicious charges that do not align with the actual visit, it can be considered that
the doctors are engaged in unlawful billing.

6. CSI –Secure Solutions
Website = https://www.csi-securesolutions.com/
Telephone : 1-888-896-0001