The U.S. Department of Health estimates that health care fraud costs the insurance industry tens of billions of dollars each year. The federal government takes an active interest in pursuing Medicare and Medicaid fraud investigations involving individual health care providers and medical institutions. If you’ve become the target of a Medicare or Medicaid fraud investigation in Illinois, you need the assistance of an experienced attorney to protect your rights.
What constitutes health care fraud?
Health care fraud is defined as the intentional misrepresentation or miscoding of health care transactions by a provider, employer group, employee or member for the sake of personal financial gain. There are a wide range of activities that may trigger a federal investigation for health care fraud. These are serious charges and you need an experienced lawyer to represent you. Some of the most common examples of health care fraud include the following:
- Billing Medicare or Medicaid for services that were not provided
- Billing for services that are not medically necessary
- Billing for more expensive services than were actually provided
- Billing services for “ghost” patients
- Providing unnecessary or medically worthless services
- Kickback schemes involving patient referrals for financial gain
- Conflicts of interest
- Prescribing fraudulent medications
- Falsifying medical records
Ultimately, it’s up to the prosecutor in charge of your case to prove that any acts of alleged fraud were committed deliberately. We can assist you in developing an appropriate defense strategy to help you successfully fight federal health care fraud charges.
What are the penalties for Medicare and Medicaid fraud?
Medical fraud cases are prosecuted by the U.S. Attorney’s Office under various federal fraud statutes. Depending on the circumstances surrounding your case, you may also be prosecuted for additional charges, including theft, embezzlement, false claims, false statements, bribery, mail fraud and wire fraud. The penalties for health care fraud include hefty fines, possible jail time and the potential loss of a medical license for health care providers. The following is a brief outline of some of the possible penalties you may face if convicted of Medicare or Medicaid fraud.
- False Statement Act – If you’re found guilty of intentionally providing false statements, you may be subject to a fine of up to $10,000 and/or a prison term of up to five years.
- Social Security Act – If you’re convicted of health care fraud involving bribes or kickbacks, you may be subject to a fine of up to $25,000 and/or a prison term of no more than five years.
- Civil Monetary Penalties Law – Health care providers who are found guilty of Medicare fraud may be subject to a $10,000 fine for each act of fraud under the Civil Monetary Penalties Law.
- Federal Mail and Wire Fraud Laws – Instances of health care fraud involving mail or wire fraud may be punishable by a fine of up to $1,000 and/or a prison term of up to five years for each act.