What are the Possible Penalties for a Charge of Healthcare Fraud and Abuse?

With the rising cost of healthcare, it should come as no surprise that fraud and abuse are significant problems. The government has a vested interest in rooting out this fraud since it runs one of the largest healthcare insurance companies in the country, providing healthcare to 74 million individuals. You know it as Medicaid. Private insurers are just as attuned to fraud and abuse because they take extra care of their profits and stockholders.
With the myriad of ways in which healthcare fraud and abuse can be committed, there is a corresponding constellation of penalties, designed to fit the type and size of the crime. Here are some examples:

  • A few months ago, we discussed six of the most common types of healthcare fraud. The crimes ranged from:
    • Fraudulent billing either for services that were never rendered or for the wrong services
    • Converting non-covered services into covered services
    • Failing to collect co-payments or deductibles
    • Over treating
    • Full on bribery and/or kickbacks
  • The crimes range from the possibly negligent to the completely purposeful and illegal. Despite this, the range of penalties will not solely depend on the gravity of the crime. The type of fraud involved will also have a great deal to do with the penalties.
  • The bar for long jail time in healthcare fraud is relatively low, at $50,000. Even fraud totaling less than $10,000 carries up to five years in prison. As the fraud amounts rise, so does the jail time. In addition to incarceration there are also fines, usually up to five times the amount of the fraud. And this is just under Florida state law.
  • Federal law covers fraudulent billing, of course, but it is a one-two punch set up to punish those who commit fraud: You can be charged under the False Claims Act (for fraudulently filed claims for benefits) and under the False Statements Act (for when a healthcare provider gives the federal government fraudulent information to induce it to reimburse for services). Individuals and corporations can be convicted under the False Claims Act with fines of up to $250,000 for an individual and $500,000 for a corporation.
  • The False Statements Act also can be invoked by the charge, meaning with each new false statement one makes, a new charge can be made against the perpetrator, with each worth a maximum of $100,000 in fines and up to five years in federal prison. It’s easy to see how quickly these can add up.
  • The ante rises for crimes of bribery and kickbacks, precisely because these crimes are virtually always purposeful and done with the intent to defraud. In addition to the garden variety penalties of jail time and fines, the perpetrators can be excluded from federal health programs in the future. An excluded person is prohibited from directly billing Medicare for any items or services. It also limits that person’s ability to work for or contract with parties who receive federal health care funding.

While there is certainly legitimate and deliberate healthcare fraud perpetrated every day, it is also true that many fraud charges are the result of errors, oversight, or misinterpretation of actions and statements. It is often a time-consuming and difficult business to sort through the noise, and the state district attorney or U.S. attorney will not be inclined to spend their time and budget figuring it out. This is why if you are facing fraud charges as a healthcare provider or contractor, it is imperative to have counsel on your side who understands the nuances of healthcare law and can advise you as to the reality of the situation. The attorneys at Weisberg Kainen Mark, PL are ready to help you understand the charges you may be facing. Contact the office today to get started.

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