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My friend underwent surgery for a gastric sleeve, in

February 2012. She has had...
My friend underwent surgery for a gastric sleeve, in February 2012. She has had a plethora of gastrointestinal problems that required further surgeries. Further testing revealed that she did not have a gastric sleeve, but a gastric bypass. However, the surgeon fraudulently billed Medicare for the more expensive gastric sleeve surgery, even though this was shown not to be done. What violations did the surgeon commit? What are the potential remedies, and to what agencies like Medicare should this fraud be reported? Please advise. Thank you for your assistance in this matter.
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Customer reply replied 8 months ago
Of note, my friend just recently found out about the fraud when she obtained her medical records. How long does she have to file a lawsuit against the doctor and the hospital? Please advise. Thank you.
Answered in 20 minutes by:
10/22/2017
DamienJD
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Hello: My name is ***** ***** I am an attorney. Please give me a moment to review your question. I may ask some questions to clarify issues.

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Did your friend after inform the surgeon or Medicare or her private insurance company, if any? Also, did your friend have to pay more out of pocket for the service?

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Customer reply replied 8 months ago
she said she recently filed a fraud complaint with Medicare. Is there still time to notify her secondary insurance provider of the fraud, which is also federal? She said that she did not have to pay more out of pocket expenses except her Medicare deductible.

The statute of limitations for fraud is 5 years for civil claims and 56 years for criminal claims. In any event, if the secondary insurance paid for services that did not occur, there is nothing preventing her from informing them.

Just to let you know, the False Claims Act (FCA) is designed to prevent overcharging of Medicare or the use of substandard health care goods and services billed to Medicare. This act imposes both civil and criminal consequences for any person who knowingly submits a false claim to the federal government. The civil penalties involve paying up to 11,000 dollars in fines for each fraud instance. Another punishment for Medicare fraud is compensating the government up to three times the amount of the false claim.

If you want to discuss further, just let me know.

DamienJD
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