Who Can the Feds Charge with Medicare Fraud?

Medicare fraud in the United States can take a variety of different forms. However, all types of Medicare fraud have the same objective – specifically, using illegitimate means to unlawfully collect money from the federal Medicare program.

Medicare fraud occurs when an unentitled claimant seeks reimbursement from Medicare. Medical providers, including doctors, as well as health care company owners and executives, could be charged with Medicare fraud. Since Medicare is run by the federal government, these fraud offenses are prosecuted on the federal level.

If you are ultimately convicted of Medicare fraud, you could be facing extremely harsh criminal penalties, including jail time and fines. Knoxville criminal defense lawyer John Barnes of Barnes Law is experienced at defending individuals who are facing criminal charges, including Medicare fraud charges. Give us a call today at 865-805-5703, or contact us online, to find out how we could assist you with your legal matter.

Various Types of Medicare Fraud

Various types of Medicare fraud exist under federal law, and individuals – including health care providers – convicted of Medicare fraud will likely face stiff penalties. Some of the most common types of Medicare fraud which are prosecuted under federal law include the following:

Fraudulent Billing

In some instances, a health care provider’s patient may be in on a Medicare fraud scam. Under this scenario, the patient, in exchange for receiving a kickback or other financial incentive, provides his or her Medicare number. The health care provider then fraudulently bills Medicare for any reason, whatsoever, and tells the patient (who is cooperating with the scheme) to admit that, in fact, he or she actually received the treatment in question. In these cases, both the health care provider and the patient could be deemed part of the fraudulent Medicare scheme.

Billing for Services Not Provided or Medically Unnecessary Services

Sometimes, health care providers bill Medicare for medical procedures or treatments that are never actually performed or which are not even necessary in the first place. At other times, these individual health care providers might fraudulently bill Medicare for medical tests which are never actually performed or for unnecessary medical tests. They could also bill for medical equipment which is not necessary – or for new equipment which has actually been used previously (but which the provider bills as new).

Fraudulent Upcoding

Sometimes, health care providers engage in a fraudulent Medicare “upcoding” scheme. They do this by inflating the patient’s medical bills using an improper billing code. The code wrongfully shows that a particular patient requires a medical or surgical procedure, when, in fact, the patient requires no such procedure.

Defending against Medicare fraud charges requires a strong legal defense. Knoxville criminal defense attorney John Barnes of Barnes Law can investigate your charge and assist you with formulating a strong legal defense to your pending fraud charge.

Reporting Instances of Medicare Fraud

In many cases, the United States Department of Justice (DOJ) relies upon other healthcare professionals who supply information about instances of Medicare fraud. Individuals who report Medicare fraud are legally protected from retaliation by an employer. They are also eligible to collect a maximum of 30 percent of any fines collected by the federal government due to the information which the so-called “whistleblower” provided.

Prosecuting Instances of Medicare Fraud

The Office of the Inspector General for the United States Department of Health and Human Services (HHS) is tasked with protecting the integrity of both Medicare and Medicaid programs. The HHS Office of Investigations collaborates with the Federal Bureau of Investigation (FBI) when it comes to investigating instances of Medicare fraud throughout the country. In fact, the Affordable Care Act of 2009 provides significant funding which is used to investigate doctors who engage in both intentional and unintentional Medicare fraud through the use of inappropriate billing practices.

When it comes to investigating instances of Medicare fraud, investigators will often use a variety of techniques. Those techniques include closely scrutinizing an accused health care provider’s medical billing patterns and using data analytics.

In order to find an accused healthcare professional guilty of Medicare fraud – or to convict that provider – the government must satisfy the required burden of proof. Specifically, the federal prosecutor must be able to demonstrate, beyond a reasonable doubt, that the health care provider engaged in fraudulent activity. If the health care provider is ultimately found guilty or convicted of Medicare fraud, then he or she will likely be facing some heavy penalties.

Knoxville criminal defense lawyer John Barnes of Barnes Law can determine whether or not the government satisfied its burden of proof in your case.

Potential Penalties upon being Convicted of Medicare Fraud

Potential penalties for individuals who are convicted of committing Medicare fraud are prescribed by the Federal Sentencing Guidelines. The potential sentence imposed against the health care provider upon conviction depends largely upon the amount of the alleged fraud. Individuals who are ultimately convicted of Medicare fraud could be sentenced to some or all of the following:

  • Incarceration
  • Fines
  • Restitution to the appropriate party or parties
  • Deportation (if the individual who is convicted of Medicare fraud is not a citizen of the United States at that time)

Offending healthcare providers could also be required to return all overpayments to the Centers for Medicare and Medicaid Services (CMS) within a period of 60 days, or risk facing additional consequences.

Knoxville criminal defense attorney John Barnes of Barnes Law can work with you to help minimize any potential penalties upon conviction in your Medicare fraud case.

Call Us Today to Schedule a Free Case Evaluation with a Knoxville Criminal Defense Attorney

If you have been charged with Medicare fraud, you must take swift and deliberate action to retain experienced legal representation. Attorney John Barnes of Barnes Law can explain all of your legal options to you and can help you select the best possible option for you and your criminal case.

Time may be of the essence. To schedule a free consultation or case evaluation with a Knoxville criminal defense lawyer, please call us today at 865-805-5703, or contact us online.