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Medicare fraud can result in civil monetary penalties.

Millions of people across America receive health care paid for by state and federal governments. In Florida, people on Medicare often see their doctor for medical treatment and then that doctor bills the government for the medical services provided. The government then compensates the doctor, hospital or health care provider using taxpayer money.

Medicare fraud and abuse occurs when those reporting officials issue false invoices to the government claiming they deserve payments for services they never rendered or for medicines never issued to the patient. Another example of Medicare fraud might arise in a doctor, hospital or health care provider altering paperwork to reflect additional treatment or more expensive medical items.

In essence, Medicare fraud happens whenever health care providers seek to obtain something of value by misrepresenting a material fact. Increasingly, organized crime has sought to get in on the Medicare fraud bandwagon. In particular, prescription drugs offer a lucrative street value. Health care providers sometimes commit Medicare fraud by issuing unneeded prescription for controlled drugs, which are then converted into cash on the black market.

Although it may seem lucrative, federal law provides stiff civil monetary penalties for Medicare fraud. Under 42 U.S.C. Section 1320a-7a, these penalties can range anywhere between $10,000 and $50,000 per violation depending on the circumstances.

A criminal defendant charged in Florida with Medicare fraud should know that federal law allows for the government to assess a penalty of up to three times the amount claimed on each fraudulent item or service or up to three times the amount received as payment from Medicare. Defendants facing such stiff penalties should consult their attorney regarding possible defense strategies or even guilty plea settlement negotiations.

Source: Department of Health and Human Services Centers for Medicare & Medicaid Services, "Medicare Fraud & Abuse: Prevention, Detection, and Reporting" Jul. 28, 2014

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Coral Gables Office

Frank A. Rubino, Esq.
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Coral Gables, FL 33134

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