The Ultimate Guide To Medicare Fraud

November 24th, 2022 by haber Leave a reply »

Summary: This article is a guide to Medicare fraud in the US and it cites laws related to Medicare fraud, examples of such fraud, and penalties.

Medicare fraud schemes have been getting more sophisticated by the day, and the US government has made the implementation of anti-fraud laws more stringent. This has facilitated the uncovering of many attempts and instances of Medicare fraud against the government. However, this fraud has also made many unwitting healthcare providers and medical practitioners end up at the wrong end of the system for fraudulent acts they were not even aware of. Given this strictly regimented scenario, it is imperative that medical practitioners and institutions keep a healthcare fraud attorney on their retainer. Read on to know more.

Laws related to Medicare fraud

Medicare fraud in the US primarily attracts the penal provisions of four federal statutes – the False Claims Act, the Federal Healthcare Law, the Stark Law, and the Anti-Kickback’Statute. Of these four laws, the False Claims Act has the broadest scope as it protects ‘against false and fraudulent claims in any form made against the government. The Anti-Kickback Statute specifically aims at compensation agreements that are illegal and involve payments from Medicare, and the Stark Law is aimed at self-referrals by physicians. In addition to this, Medicare fraud also attracts many ancillary offenses like money laundering, wire fraud, mail fraud, and other white-collar crimes. This broad spectrum of liabilities is best defended by a healthcare attorney who is trained in the specific laws related to Medicare fraud and in the ancillary laws related to Medicare fraud prosecutions.

Examples of Medicare fraud

If any action leads to the collection of payment from the Medicare system without a legitimate right to such payment, it is termed Medicare fraud. Such actions come in many forms, including coding violations, unbundling, upcoding, billing violations, documentation fraud, prescription fraud, facilitating unlawful billing, etc. Even unintentional mistakes in billing caused by human error can be prosecuted for Medicare fraud. Therefore, medical practitioners and institutions are advised to hire Medicare fraud defense attorneys to evaluate their practice for any actions that could attract Medicare fraud prosecution.

Penalties for Medicare Fraud

A healthcare attorney will be able to advise you regarding the various penalties imposed for Medicare Fraud. The Federal Healthcare law subscribes imprisonment, substantial fines, and exclusion from healthcare benefit programs. The civil monetary penalties law imposes civil penalties (monetary) of between $10,000 to $50,000 per false claim, damages worth triple the amount the government is defrauded of, and recoupment of overbilled amounts. It also imposes criminal liabilities, including fines and incarceration of up to 5 years per violation. The Anti-Kickback Statute also provides for both civil and criminal penalties. The civil penalties are similar to that of the False Claims Act, and the criminal fines extend to $25,000 per violation and imprisonment of 5 years for every offense. Other general penalties include loss of hospital privileges, non-payment of claims in the future, and program exclusion.

Attorney Haber has been experienced in Medicare fraud from service in the US Attorney office to the present.

Call Attorney Haber if you know of Medicare fraud or are being investigated and prosecuted for such fraud. 301-670-0016


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