Medicare fraud can happen in a variety of circumstances. If a physician, pharmacist, or other medical professionals knowingly submits or are the cause of submission of a false claim for a federal health care payment, they may face fraud charges. Medicare fraud charges can also occur in the case of kickbacks or when prohibited referrals are made for certain designated health services.
The federal government takes Medicare fraud charges seriously. It’s important to understand the various laws which govern fraud charges and the potential penalties you may face if convicted. You should never take these types of allegations lightly.
Federal Civil False Claims Act (FCA)
The FCA is designed to help protect the government from being overcharged or for being sold substandard goods and services. For example, you could face charges under the FCA if you knowingly submit a claim to Medicare for medical services you did not provide. You could also be charged if you submit a claim for medical services at a higher level than those you actually provided.
The possible civil penalties for violating the FCA include up to three times the damages sustained by the federal government as the result of a false claim. You could also face additional financial penalties for each false claim you filed. Criminal penalties may include additional fines and imprisonment.
Anti-Kickback Statute (AKS)
The name of this law is pretty self-explanatory. You could face charges under this law if, for example, you receive a rent break on office space in exchange for referrals. Certain “safe harbor” regulations can protect providers who may otherwise have been implicated under the AKS.
Possible penalties include fines, imprisonment, and exclusion from participation in federal health care programs. You could also face financial penalties in the amount of up to three times the value of the kickback.
Physician Self-Referral Law (Stark Law)
This law prohibits physicians from referring a patient covered by Medicare to an entity with which the physician or an immediate family member has a financial relationship. There are some exceptions to this rule.
Potential penalties include fines and exclusion from participation in federal health care programs.
Legal defenses are available
You should discuss any Medicare fraud charges with a skilled legal professional. There are numerous exceptions to these laws. Other legal defenses may also be available. Remember that you have rights. It’s important to build a vigorous defense against both civil and criminal charges.