What are the potential penalties for common types of Medicare fraud?

Medical professionals can benefit from understanding the federal penalties for false claims, kickbacks and other forms of Medicare fraud.

In recent years, prosecuting Medicare fraud has become a growing focus for federal authorities. Over the past decade, more than 2,100 people have been charged with this offense, according to the Centers for Medicare & Medicaid Services. Those convicted often face serious consequences, including an average of at least four years in prison. In light of these trends, most medical professionals in Coral Gables can benefit from understanding the penalties for various forms of Medicare fraud.

False claims

Professionals who are accused of submitting false medical claims, engaging in fraudulent medical billing or creating false records may face various penalties under the False Claims Act. These include incarceration for up to five years and criminal fines worth up to $250,000, according to the CMS. In some cases, however, professionals might be able to contest these criminal charges by showing that they didn't know and shouldn't reasonably have known that a claim was fraudulent.

Giving or taking kickbacks

The Anti-Kickback Statute defines kickbacks as anything of value that one party gives a second party in return for referrals or other actions that generate business for the first party. Medical professionals convicted of offering or accepting kickbacks may face the same penalties as people convicted of submitting false claims. Additionally, according to the website of the Office of Inspector General, people convicted under the Act may be barred from future participation in health care programs administered by the federal government.

General health care fraud

Professionals convicted of engaging in fraudulent schemes that target a health care benefit program can face even more severe sanctions under the Health Care Fraud Statute. According to the CMS, these individuals may be imprisoned for up to 10 years. If an alleged scheme causes another person's injury or death, the maximum possible periods of incarceration rise. Furthermore, individuals who have been convicted of health care fraud may be ordered to pay fines worth up to $250,000.

Additional penalties

Professionals who are accused of any of these violations may also face substantial civil fines. The fine for each false claim is $11,000, while the fine for every kickback is $50,000. The government may also levy a fine worth triple the amount of any financial damages that it suffered as a result of a medical provider's alleged misconduct.

Challenging fraud charges

Given these serious penalties, it is critical for professionals who have been accused of any form of Medicare fraud to consider seeking legal advice as soon as feasible. An attorney with experience in these complex cases may be able to help a person mount a defense against unwarranted charges or seek more reasonable sanctions in the event of a conviction.