Medicare fraud is a criminal act that costs the federal health care program billions of dollars in false claims every year. It involves an individual or entity billing the program for medical services that the patient did not receive. This wasted money causes an increase in overall healthcare costs and taxes across the country.

There are Different Types of Medicare Fraud

There are several ways for individuals or entities to commit Medicare fraud. A health care provider or medical supplier may bill the program for services or equipment that the patient never received. Other examples include using fake information to deceive a patient into joining a Medicare plan and offering a Medicare prescription plan that is not Medicare-approved. Additionally, an individual could use another patient’s Medicare card to obtain medical assistance, equipment or other supplies.

Convictions Result in Severe Penalties

Several laws govern the penalties that individuals or entities face with health care fraud convictions. The False Claims Act discusses penalties for individuals who make false records or statements and knowingly submit false payment claims to the government. Under the FCA, the penalty could be up to $11,000 for each fraudulent claim, plus three times the damages against the government.

Under the Civil Monetary Penalties Law, the Office of Inspector General of the U.S. Department of Health and Human Services has the authority to impose between $10,000 and $50,000 in fines for violations, such as:

-Making fraudulent statements to join Medicare

-Not administering adequate medical screening for an emergency room patient in labor or who has an emergency condition

-Providing misleading or false information to influence the discharge of a patient

-Submitting false claims

-Violating the physician agreement or assignment provisions

Fighting Medicare Fraud Begins With Patient Awareness

Federal and state governments are working to make Medicare patients more aware of how they can protect their information. The main advice that they give is treating Medicare cards like credit cards and keeping track of payments for doctor visits, treatments and medical equipment to ensure that no unauthorized claims are made. As an incentive to report Medicare fraud, patients may receive a reward of up to $1,000 if their reports meet certain conditions.

Prevention Efforts Have Recovered Billions

Governments have teamed up with insurers, law enforcement and health care providers to stop fraud. Four programs represent the support for this effort, including The Affordable Care Act and the Public-Private Partnership to Prevent Health Care Fraud.

Since the Health Care Fraud and Abuse Control Program was formed in 1997, $27.8 billion has returned to the Medicare Trust Fund. Since the Medicare Strike Force began operation in 2007, it has lodged 1,285 criminal actions and charged over 2,300 defendants.

Let the Khonsari Law Group Defend You

Defending yourself against charges of Medicare fraud could be difficult to do if you do not understand all of your rights. Allow the experienced attorneys at the Khonsari Law Group to build a strong case for you and represent your rights. Call us or fill out our contact form for a free consultation.