What is Medicare fraud in Florida?

Medicare fraud, which can manifest in a number of ways, is a federal felony that carries with it serious penalties.

A Florida man who owned a home health care agency admitted that he was billing the Medicare program for services that were either not provided or were not necessary. Over the course of about five years, the agency billed up to approximately $35 million in claims, $21 million of which were paid through the program. According to the U.S. Department of Justice, the man pleaded guilty to conspiracy to commit health care fraud.

Medicare fraud is a white collar crime that can result in serious consequences for those who face such charges. People who operate health care facilities or otherwise use the Medicare program should know what constitutes illegal activity.

Types of Medicare fraud

The Centers for Medicare & Medicaid Services report that fraud can manifest in a number of ways. In addition to billing the program for services that were never rendered, as the above case illustrates, the following fraudulent activities are also illegal:

  • Allowing someone else to use a Medicare card that is not his or hers to secure supplies or services
  • Billing the program for equipment that was never received
  • Giving someone false information to entice them to sign on with a Medicare plan

Knowingly providing false information or otherwise misrepresenting the truth to obtain payments could result in fraud charges. For example, overcharging Medicare for services that actually were provided could still be considered fraud because it is a misrepresentation of fact.

The consequences

Medicare fraud is considered a federal felony. According to CMS, there are a number of federal laws in place that govern the way Medicare fraud is charged and penalized. For example, the False Claims Act makes it a crime to overcharge the government. The penalties for doing so include a fine of up to $11,000 as well as a penalty that can be as much as three times the amount of damages the action caused.

Criminal penalties are also a possibility, depending on what transpired. Someone convicted of a white collar crime may be sentenced to time in jail.

Defending fraud charges

One of the most important aspects of Medicare fraud is that in order for it to be a crime, the person in question must have knowingly committed the act or acted recklessly or negligently. Therefore, if someone in Florida loses his or her Medicare card and someone else uses the account information, it is possible that the original cardholder may not be held responsible for the damages involved.

It is also possible that a coding error could trigger a fraud investigation. A billing or coding violation could be a simple misunderstanding instead of a purported attempt to defraud the government.

Anyone who has been approached by a Government Agent about Medicare fraud should contact the Law Office of Frank A. Rubino.