Under 18 U.S.C. ยง 1347, certain types of Health Care Fraud are punishable by imprisonment of up to 10 years and up to 20 years if the fraud causes bodily injury.
Whether as a result of intentional conduct, a simple oversight, or the rogue actions of one of your employees, false claims and other issues relating to Medicare can have life-changing implications. The Centers for Medicare & Medicaid Services and the Office of Inspector General of the U.S. Department of Health and Human Services are cracking down on Medicare fraud, and as a result physicians and other health care professionals are increasingly facing serious charges across the country.
Put our highly experienced team on your side
Brian J. Kuester
Former U.S. Attorney
Former DA
Amanda Marshall
Former U.S. Attorney
Local Counsel
Joe Brown
Former U.S. Attorney
& Former District Attorney
Local Counsel
John W. Sellers
Former Senior Trial Attorney
U.S. Department of Justice
Local Counsel
Linda Julin McNamara
Former Chief, DOJ Appeals
Local Counsel
Joanne Fine DeLena
Former Assistant U.S. Attorney
Local Counsel
Aaron L. Wiley
Former Federal Prosecutor
Local Counsel
Roger Bach
Former Special Agent (OIG)
Chris Quick
Former Special Agent (FBI & IRS-CI)
Kevin M. Sheridan
Former Special Agent (FBI)
Ray Yuen
Former Supervisory Special Agent (FBI)
Dennis A. Wichern
Former Special Agent-in-Charge (DEA)
Medicare Fraud Explained
The term “Medicare fraud” actually encompasses several specific crimes under a broad range of federal laws. However, the statute the government most frequently uses to bring Medicare fraud claims is the federal health care law, 18 U.S.C. Section 1347. This law states:
“Whoever knowingly and willfully executes or attempts to execute, a scheme or artifice”(1) to defraud any health care benefit program; or (2) to obtain, by means of false or fraudulent pretenses . . . any of the money or property owned by, or under the custody or control of, any health care benefit program, in connection with the delivery of or payment for health care benefits, items, or services, shall be [subject to criminal penalties].
As you can see, this law is extremely broad and applies not only to successful Medicare fraud schemes but to attempted frauds as well. This gives the federal government significant leeway in crafting allegations in order to pursue criminal convictions. Our attorneys are intimately familiar with the government’s tactics in this arena. As a result of this experience, have been successful in helping numerous clients have their healthcare fraud charges dismissed.
Other laws that can be used to bring Medicare fraud charges include anti-kickback laws, the False Claims Act, the Social Security Act, and the Stark Law. Similar to the federal health care law, these laws make it illegal to make false representations or use fraudulent schemes in order to overbill for Medicare.
Activities that are Commonly Charged as Medicare Fraud
Our medicare fraud defense attorneys have significant experience defending clients against a wide variety of Medicare fraud and other health care fraud allegations. Some common examples of activities that can be charged as Medicare fraud include:
- Billing for services that were never provided
- Overcharging for services provided
- Upcoding
- Code jamming
- Unbundling services in order to receive a higher payment
Medicare Fraud and the Affordable Care Act
With the passage of the Affordable Care Act (also known as ObamaCare), federal agencies now have additional tools and resources for pursuing Medicare fraud allegations. For example, the Center for Medicare & Medicaid Services has access to predictive modeling technology to identify possible frauds, and “high-risk” providers are subject to enhanced scrutiny. Since the law’s enactment in 2010, the government has recovered more than $10 billion for Medicare and other forms of health care fraud.
Defending Against Medicare Fraud
While laws such as the Medicare Fraud and the Affordable Care Act make it easier for the government to press charges, they do not necessarily serve the best interests of the health care industry. Such automated assessments and invasive investigations often lead to false allegations, costing physicians and other providers time and money, and in some cases putting their reputations on the line. At the The Criminal Defense Firm, we work closely with our clients to challenge unjust accusations and fight unwarranted audits and investigations.
Penalties for Medicare Fraud
The penalties for Medicare fraud can be extremely severe. For instance, under the federal health care law quoted above, the sentencing guidelines call for steep fines and up to 10 years in prison for a standard offense. In cases involving serious bodily injury, defendants can face up to 20 years in prison, and in cases involving death, they can face life behind bars. Under the Affordable Care Act, the penalties for Medicare fraud have been increased by up to 50 percent for crimes involving over $1 million in losses.
If convicted, you can also be barred from future participation in any Health and Human Services (HHS) benefits programs.
Speak with a Medicare Fraud Defense Lawyer about Your Case
When your practice or business is on the line, you need to take decisive action to ensure that you are presenting the strongest possible defense. Our experienced criminal defense lawyers and former federal prosecutors have years of experience helping clients obtain dismissal of Medicare and other health care fraud claims. If you are facing a federal investigation or federal charges, calling The Criminal Defense Firm can change your life.
To schedule a free, confidential consultation, call 866-603-4540 or contact us online today.
Geographic Areas
Michigan
Oregon
Last Updated: