By Criminal Defense Lawyer Jeremy Rosenthal
Medicare fraud is hotly prosecuted by the Department of Justice where they accuse medical providers of a host of different criminal activities. Common accusations include fraudulent or over-billing and “kick-back” schemes where a person receives money for referring a medicare patient to a health care provider.
The federal government also often prosecutes what they consider to be conspirators or accomplices. So simply because a person doesn’t work directly for a medical provider doesn’t mean they’re “out of the woods” on a medicare fraud prosecution or investigation.
What are the Possible Punishments for Medicare Fraud?
If you think you’re being accused – then this is probably the first thing on your mind. Unfortunately there is no truly one-size fits all answer. Medicare fraud is a general term but in reality there are several different statutes which cover different types of allegations. It depends on a handful of factors such as what type of medicare fraud is being accused and the monetary amount of the alleged fraud.
Penalties can include jail time, civil fines, and future exclusion from the Medicare Program.
You can read the statutes government medicare fraud here.
Fraudulent or Over-billing Medicare
Billing medicare for unnecessary work as well as billing for work never done at all is a big source of medicare fraud cases. Also, incorrect insurance coding can be investigated so health care providers must take special care to be on top of those seemingly mundane office responsibilities.
A kick-back is where a person receives compensation for steering or sending patients to someone who will use medicare as a billing mechanism. The compensation doesn’t necessarily have to be direct — other words where a physician joins an investment group of some type along with a patient referral source – the federal prosecutors could allege the investment group is a cover for kick backs.
Medicare Fraud is Extremely Complex and the allegations are very serious. I tell my clients the Federal Government’s money “burns to the center of the Earth.” By that I mean the department of justice is relentless in getting what they think they’re owed.
Take action immediately if you are being investigated for medicare fraud. It’s not a situation you can easily talk your way out of.
*Jeremy Rosenthal is board certified in criminal law by the Texas Board of Legal Specialization. He is designated as a Texas Super Lawyer by Thomson Reuters.