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Penalties for Fraud by Medicare Providers

Medicare fraud is illegal and expensive. According to Insurancefraud.org, Medicaid and Medicare both lose about $60 billion or more to insurance fraud on an annual basis. Moreover, Medicare sets aside $465 billion annually to combat this kind of fraud. Therefore, penalties for such abuse are stiff and harsh.

  1. False Claims

    • According to Aapsonline.com, if you are a health care provider that files a false claim for medical services that you failed to provide, didn't render as you have stated, or that were medically unnecessary, you could be subject to five years behind bars, a $250,000 fine as an individual and double that for a corporation, or both. The prosecution needs to prove intent, meaning it must be established that you did the crime willfully, and with the intent to deceive. Moreover, each separate offense, or count, carries its own jail time and fines.

    Lying

    • This includes making false statements, or covering up material facts. Again the prosecuting attorney needs to prove that you, the health care provider, falsified statements with the purpose of deceiving Medicare (or Medicaid). If you are successfully convicted, be prepared to possibly pay a $10,000 fine, and serve five years in prison, or both.

    Kickbacks

    • Soliciting monies or services, or receiving them, in exchange for gifts, financial rewards, or services that Medicare covers, is also a crime. Penalties for this could include a fine of $25, 000 and/or serve five years of incarceration.

    Communications Fraud

    • Do not use the mails, TV, or the Internet to further a Medicare or Medicaid scam. If a prosecutor can prove that you used certain forms of media to advance such deceit to the public, you could net five years in the penitentiary, plus a $1,000 fine.

    New Law, New Penalties

    • According to the Aapsonline.org, due to the recent passage of the Kennedy-Kasselbaum Act, if you scheme to defraud any health care agency, you may draw penalties of up to 10 years of imprisonment, plus any court costs, fines, or financial penalties the court deems fit to assign you. If an injury occurs due to your schemes, 20 years plus fines could be your lot. If death occurs, you could end up serving a life term.

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