Millions of people depend on Medicaid and Medicare programs to help offset the costs of important medical expenses, such as doctor visits or filling prescriptions. Because these two programs are used by so many people and involve large quantities of money being paid to the program users, government officials monitor the payouts closely for acts of fraud. Although many people use Medicare and Medicaid legally, instances of fraud involving these two programs is common and can take several forms.
Medicare and Medicaid Fraud Cases
Attempting to defraud or successfully defrauding the Medicare or Medicaid programs constitutes a federal offense because the federal government is responsible for paying out the benefits. As such, the federal government keeps a close watch on certain activities that are frequently associated with fraud attempts.
For example, a medical procedure that is billed to Medicare by a medical professional repeatedly and frequently in a short period of time may indicate an attempt to receive undue compensation. Repeated charges for an expensive procedure or disproportionately high charges might also be indications of attempted health care fraud. Whatever the case, the federal government takes all suspicious billing activity very seriously, and the penalties for a medical fraud conviction are severe.
Penalties for Medicare/Medicaid Fraud
The legal ramifications for this type of fraud conviction can vary depending upon the circumstances of each case but are generally very strict. For example:
- A felony conviction can carry a sentence of up to five years in prison per count for the convicted person, even for a first-time offense.
- A company or corporation that is convicted of felony Medicare or Medicaid fraud can be fined up to $500,000 per count. A misdemeanor conviction can bring a fine of up to $250,000 for a corporation.
- A person found guilty of misdemeanor Medicare fraud can face a fine of up to $100,000, even for a first-time offense.
Defending Against One’s Charges
Being investigated by the federal government on suspicion of Medicare or Medicaid fraud is a very serious matter. In order to prepare a solid legal defense, a Medicare fraud attorney can study the facts of the case and determine if billing errors have been made. Such errors are quite common because the process of assessing and billing charges to Medicare can become complex, especially for a busy health care professional or an individual with a rare condition. If a Medicaid fraud attorney can provide strong evidence that either the government or an individual made a billing error that only seemed to be fraudulent, the prosecution may drop or reduce the charges.