There are a number of ways to commit healthcare fraud through Medicare or Medicaid, crimes that cost the government billions of dollars each year.
Those accused of Medicare or Medicaid fraud face heavy fines and the possibility of imprisonment, but are such cases tried in state or federal court?
Both Medicare and Medicaid statutes forbid the making of false statements, submitting false claims or engaging in kickback schemes. The prosecution of a healthcare fraud case must develop using a thorough knowledge of the reimbursement methods in the case. For example, Medicare reimbursement may be cost-based, charge-based or handled according to a fee schedule. Due to the complex nature of the crime, healthcare fraud investigations are normally painstakingly detailed and time-consuming. As soon as the target of a healthcare fraud investigation learns that the process is underway, he or she should seek legal guidance immediately.
Petit jury and grand jury
At the federal level, there are two kinds of juries. A trial or petit jury decides whether a defendant committed the crime charged in a criminal case or whether he or she caused injury to the plaintiff in a civil case. A grand jury looks at evidence the U.S. attorney provides to decide whether there is probable cause to believe someone committed a crime. If so, the grand jury will issue an indictment.
State versus federal
The establishment of Medicare Fraud Control Units, which have begun to operate in many states, has generally resulted in a separation of cases. The Medicaid program is normally a state concern while a case of Medicare fraud is more often heard in federal court, and a defense attorney will build a strategy to suit.