Medicare is a federal health insurance program designed for individuals age 65 and older and for certain young people who have disabilities. It is also for people suffering with end-stage renal disease. Part A of the program is hospital insurance (covers hospital stays), whereas Part B of the program is medical insurance (covers doctors’ services and medical supplies among other things).
Like other health insurance programs, people can abuse the Medicare program and even commit Medicare fraud. According to cms.gov, “Although no precise measure of health care fraud exists, those intent on abusing Federal health care programs can cost taxpayers billions of dollars while putting beneficiaries’ health and welfare at risk.”
What Counts as Medicare Fraud?
The following are examples of Medicare fraud:
- Intentionally submitting false claims.
- Knowingly causing false claims to be submitted.
- Knowingly lying about facts to obtain payments.
- Knowingly paying someone for referrals for services reimbursed by Medicare.
- Making a prohibited referral in order to obtain health services.
- Billing Medicare for an appointment the patient failed to keep.
- Billing for services never provided.
- Billing for supplies never provided.
- Falsifying records to show delivery of services not provided.
Medicare fraud and abuse are criminalized by the United States Criminal Code, the Social Security Act, the Physician Self-Reliance Law, the False Claims Act, and by the Anti-Kickback Statute. When a health care provider violates these laws, it could lead to criminal and civil liability, civil penalties, exclusion from federal health care programs, as well as the nonpayment of claims.
Related: Tax Evasion: What You Need to Know
Under U.S. Code Sec. 1347, Health Care Fraud, the penalties for health care fraud includes fines and imprisonment up to 10 or 20 years depending on the facts of the case. If the violation resulted in death, the defendant faces up to life in prison.
Are you being charged with health care fraud? If so, contact us immediately to meet with a Plano criminal defense lawyer.