Medicare fraud allegations may lead to significant criminal and civil penalties for defendants. However, individuals or entities accused of medicare fraud may experience a range of outcomes depending on the circumstances.
News reports about medicare fraud allegations against a doctor in Texas and against a university medical system in Florida highlight the dramatically different outcomes in these cases.
Texas doctor faces prison sentence for Medicare fraud
A Click2Houston.com report indicates that a doctor in Harris County allegedly filed false claims to Medicare. The claims pertained to home health care services. The physician reportedly received significant payments as kickbacks as well. In addition to spending five years in prison, the doctor must pay $9.5 million in restitution. The case also involves other co-defendants but the report provides no details about their potential penalties.
No criminal charges filed against university health system
In contrast with the Texas case, defendants involved in a University of Miami health system will not spend time in prison. The defendants and the university deny any wrongdoing according to The Miami Herald. However, the case does come with a hefty price tag of approximately $22 million for the school.
The case arose in 2013 when the chief operating officer at the time filed a report. The case remained secret until now. The whistleblower report alleges that the university submitted bills to Medicare for unnecessary organ transplant tests.
The Department of Health and Human Services and the Federal Bureau of Investigation jointly decided not to press criminal charges against the university after evaluating all facts in the matter.