Medicare Fraud Charges and Penalties – What You Need to Know

Medicare Fraud Charges and Penalties

Medicare has provided health insurance for many individuals and many depend greatly on the services that they receive. When Medicare was originally created, it was designed to help honest doctors who helped the needy receive Medicare services. Throughout the years, Medicare fraud has become a growing program.

What is Medicare Fraud?

The entire idea of Medicare fraud is to collect money from the Medicare health care program illegitimately. In other words, it is the collection of Medicare health care reimbursement under false pretense. The fraud can go undetected for a while. Part of this reason is that the Medicare program is based on the “honor system” of billing. This aspect makes it a target for fraud and hard to catch.

History of Medicare

The concept of a national health care system to help the needy began under President Teddy Roosevelt in 1912. President Harry Truman pushed for it during his term in the 1940s, but it was rejected. President John F. Kennedy also made an attempt during his term. Medicare was finally signed into law on July 30, 1965 under President Lyndon Johnson as a national social insurance program.

Medicare is administered by the U.S. Federal Government. It is funded by payroll tax and provides health insurance for Americans who are 65 years or older who have worked and paid into the system. It can also provide health insurance to younger individuals who have disabilities.

Types of Medicare Fraud

While there are many ways to commit Medicare fraud, here are three Medicare fraud offenses you will typically see:

  1. Phantom Billing: This is when a medical provide will bill Medicare for procedures that were not need, or were never performed. They might have reported unnecessary medical tests, or claim tests that were never performed.
  2. Patient Billing: This is when the patient is involved in the scam. The medical provider will bill Medicare for a given reason and the patient will admit and lie that they have received that medical treatment.
  3. Uncording Scheme: This is when a medical provider will inflate bills by using a billing code of a particular expensive procedure.

Largest Medicare Fraud Scheme Ever

The United States Department of Justice is cracking down on Medicare fraud. This past July, three people were charged in $1 billion in a Medicare fraud scheme in Florida. It is known as the largest ever single criminal health-care fraud case. The individuals used a network of doctors, hospitals, and health-care providers across South Florida to improperly bill more than $1 Billion to Medicare and Medicaid.

The case was made known by an interagency called: Medicare Fraud Strike Force. This group in nine different locations across the country. It was created in 2007 and it has charged almost 2,900 defendants.

According to the Wall Street Journal, this group has collectively they have falsely billed the Medicare Program more than $10 Billion.

Punishment for Medicare Fraud

Currently, when found guilty of Medicare fraud, a person is looking at facing fines, prison time, and will have to pay back all the money that they stole from the government. The amount of the fine and the time served are dependent upon the violation.

For example, fines for violating the FCA (False Claims Act) range from $5,500–$11,000 per false claim. In addition, fines may result in “up to three times the amount of damages sustained by the government as a result of the false claims.”

Under the CMPL (Civil Monetary Penalties Law) penalties may be up to $50,000 per violation. Furthermore, “assessments of up to three times the amount claimed for each item or service, or up to three times the amount of remuneration offered, paid, solicited, or received.”

Seek Legal Advice

If you are facing charges for Medicare fraud, seek legal help from an experienced Medicare fraud defense attorney today. These are serious charges to be facing. It is our goal at The David J. Kramer Law Firm, PLLC to ensure that each person has a fair trial and do not have to receive any unjust punishments. Call us today.

248-348-7400 or 586-530-1000