Medicare is a federal health insurance program for Americans over age 65 and those with certain disabilities. The government pays out billions of dollars each year to healthcare providers whose patients subscribe to Medicare. Unfortunately, some providers attempt to commit Medicare fraud by billing for services the patient never received or billing at a higher rate than a service is worth. Some providers go so far as to provide healthcare services for a patient that he or she does not legitimately need.
Insurance brokers may also be guilty of Medicare fraud when they use misleading information to get clients to sign up for a plan. Another possible area of fraud against the government is using someone else’s Medicare account to obtain healthcare services or getting an unneeded prescription and then selling it.
According to StopMedicareFraud.gov, fraudulent claims costs taxpayers $60 billion per year. The website also states that up to 10 percent of the Medicare claims the government pays each year are fraudulent. Because of its enormous losses and taxpayer outrage, the federal government can sometimes be overzealous in accusing people of Medicare fraud when all that occurred was a simple mistake. If you are facing this charge, it’s important to know what is at stake and to work with an experienced Medicare fraud attorney at Speas Law Firm, LLC.
Consequences of a Medicare Fraud Conviction
To be convicted of fraud, the prosecution must prove that you knowingly and willingly engaged in a scheme or plan to defraud the government for financial gain. It is important to understand that Medicare can involve both public and private insurers and that either can be the victim of a fraudulent claim. Federal law 18 U.S.C. section 287 discusses making false claims under the Medicare program while federal law 18 U.S.C. section 1001 criminalizes false statements and all related activity. A conviction can result in a prison sentence, fine, restitution, and/or probation.
Making a false claim in relation to Medicare can result in a prison sentence of five years. If you are convicted of fraud, the sentence can be up to 10 years. The consequences become even more severe when a person suffers a serious injury or death due to fraud against the Medicare program. The sentences may be up to 20 years or life in prison, respectively.
The fines involved with a Medicare fraud conviction are staggering. Making a false statement in a claim can cost you $250,000 as an individual or $500,000 as an organization. If you are part of an organization that knowingly commits ongoing Medicare schemes, the fines could reach millions or billions of dollars.
Restitution is a separate financial punishment than fines. This involves paying back everyone who was harmed in the scheme dollar for dollar. For example, a medical supply company that billed an insurance company for items a patient never received would be ordered to reimburse the carrier for its payments.
For low-dollar crimes or first offenses, someone charged with Medicare fraud may be placed on probation instead of being sent to prison. Probation can also follow a prison sentence. As a person on probation, you are limited in where you can live, who you can associate with, and activities you can participate in as well as the requirement to remain a law-abiding citizen with gainful employment. You must also meet with your probation officer regularly.
Don’t Let the Government Intimidate You
It is understandably frightening to receive notice that the federal government has charged you with Medicare fraud. However, that doesn’t mean you are guilty. When you feel that you made an honest mistake in this regard, you need a skilled defense attorney on your side. Please contact us at Speas Law, LLC to learn more about how we can help you.
Disclaimer: The content of this article does not constitute an attorney-client relationship. Please contact Jennifer Speas to discuss the specifics of your case.