Current US law states that if you are found guilty of Medicare fraud, you can face fines and imprisonment. The amount of the fine that you receive can vary, depending upon which statute you violated.
For instance, if you made a false statement about a medical service that you know you did not receive or perform, the fine is $10,000. If you received a kickback, you can get a $25,000 fine. Note that fines can reach $500,000, depending upon your status as an individual or a company.
In addition, note that people who commit Medicare fraud will have to pay back all of the money that they stole from the government. The repayments may be equal to or exceed the amount of fines, depending upon how extensive the fraud was.
Note that penalties may be assessed in this case even if the communication was not directed to the government agency. For example, Medicare fraud can be charged when the communication question was directed towards a state agency or an insurance company.
Medicare Fraud Charge Examples
A doctor in New York was sentenced to five years in prison and ordered to pay $727,000 in restitution to Medicare, as well as $2.8 million in federal income taxes. He was convicted of health care fraud, which involved filing fake pension fund reports with the Department of Labor, and also for tax evasion in 2001 and 2003.
A naturalized US citizen from Nigeria living in Houston was sentenced to 100 months in prison and ordered to pay $26 million in restitution to Medicare. He was convicted for one count of conspiracy to commit health care fraud and one count of money laundering.
Civil Monetary Penalties
A health practitioner who is found guilty of making false statements to claim Medicare benefits can be fined as high as $10,0000 per service. The practitioner may also be banned from participating in Medicare.
Criminal Prosecution and Jail Time
People who are convicted of Medicare fraud may do up to five years in prison – PER offense. those who are charged with multiple counts of fraud may get a life sentence, once all of the counts are added together.
If you can show that your Medicare fraud was more the result of bad administration, then your organization may get administrative sanctions. These penalties can include the suspension or revocation of your license to participate in the health profession, and/or to participate in the program.
Medicare Fraud Charges by State
Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming