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The federal government takes all cases of Medicare Fraud accusation seriously. Any doctor, office, or billing agency suspected of committing Medicare Fraud is immediately investigated. If found guilty, federal charges are filed, and punishments are severe for anyone found guilty of Medicare Fraud. It’s considered a White-Collar crime in New York, and accusations are on the rise. Many cases of Medicare Fraud are found to be simple mistakes made by someone who misread important information, mistyped information, or even confused the files of two patients on a busy day. These cases are fixed, and no criminal charges are brought against the person or business accused of Medicare Fraud.
What is Medicare Fraud?
Understanding the severity of Medicare Fraud is imperative. Loosely defined, Medicare fraud is the intentional act of submitting information, falsifying documents, and working illegally and unethically to make more money by defrauding the Medicare system. It occurs regularly in many offices, and it’s a federal offense in every state. Most cases in this category fall within a specific list of accusations:
– Submitting duplicate bills for the same patient
– Charging patients for services not rendered
– Submitting fraudulent cost reports
– Mispresenting services performed intentionally and willfully
The unfortunate aspect of any of these charges is it simply doesn’t matter if it was a simple mistake or an intentional act. The federal government doesn’t take kindly to attempts to defraud them and contribute to the tens of billions of dollars they pay out annual for fraudulent charges. They will investigate, and they will look for a way to prosecute the doctor or office accused of fraud.
If a company or person is found guilty of Medicare Fraud, the penalties are substantial. Both fines and imprisonment are a possibility if you commit Medicare Fraud, and the length of time and amount of money a guilty party is issued is based on the number of charges he or she is found guilty of.
– Fines begin at $10,000 per charge. This is for charging for services an office did not perform on a patient.
– Kickbacks are subject to a $25,000 fine.
– Fines can reach as high as a half million dollars depending on the severity and type of Medicare Fraud a person is accused of.
– Restitution is required in all cases of Medicare Fraud. Every dime stolen as a result of fraud is required to be paid back to the patients and the government it was stolen from.
– Prison time varies based on the fraud committed, the number of charges filed, and the severity of the crime. The average amount of time a doctor or medical professional faces is 5 years per offense.
– Probation and the loss of a medical license are other punishments doctors and their practices face if they are charged with Medicare Fraud and found guilty in a court of law.
While doctors who own practices of their own are typically the ones investigated for Medicare Fraud, it’s not uncommon for the doctor to have no knowledge of the crime as their administrative staff is the entity responsible for handling billing and healthcare issues. If the investigation is able to prove someone in administration committed Medicare fraud on purpose or due to gross negligence, the doctor is still at risk for being punished. Administrative sanctions could be issued, and the office could still face fines, restitution, and even suspension of their health, medical, and business licenses in New York.
Medicare Fraud is one of the most serious charges filed against a doctor or doctor’s office, and it requires the experience of an attorney who has worked with cases of Medicare Fraud in the past. Doctors are at risk for facing jail time, the loss of their professional license, and a tarnished reputation. When a formal complaint is filed regarding Medicare Fraud, the doctor or office is notified immediately and required to file a response to the complaint. It’s advised no one takes legal action into their own hands without full knowledge of the law, their legal rights, and the potential ramifications of not using their legal counsel in a situation such as this one.