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Feds Make Concerted Use of Civil Monetary Penalties to Punish Medicare Fraud

Medicare makes it possible for millions of senior citizens to afford the medical care they need at an age when they’re particularly vulnerable to serious health problems. However, some doctors allegedly take advantage of this federal source of funds to pad medical bills with services that they didn’t actually render. Federal law creates both criminal and civil liability for such violations. Civil remedies include allowing prosecutors to seek heavy fines against violators to force them to disgorge their profits.

Federal prosecutors are cracking down on Medicare fraud, in part by using the False Claims Act and other statutes to retrieve payments made to doctors based on fraudulent claims. For instance, a physician in Lebanon, Pennsylvania recently settled with the U.S. Department of Justice, agreeing to pay back $86,500 in Medicare payments that the government believed were not supported by the medical records of the patients he allegedly treated.

The False Claims Act, which was used in the foregoing case, applies to any false or fraudulent claim for payment of federal funds. This includes identified overpayments under the Medicare Act that aren’t returned within 60 days. Such overpayments may result in a defendant paying $11,000 for each violation, plus three times the federal government’s damages. This is in addition to possible criminal fines of up to $250,000 as well as potential prison time.

U.S. Attorneys have several other statutory tools for imposing civil and criminal liability for Medicare fraud. These include the following:

  • Health Care Fraud Statute — This makes it a crime to knowingly and willfully defraud a health care benefit program, including Medicare. Violators can face a prison sentence of up to 10 years and a fine of up to $250,000.
  • Anti-Kickback Statute and related laws — These provisions make it a crime to accept compensation for referring patients to Medicare or Medicaid. In addition to criminal penalties of up to five years in prison and $25,000 in fines, defendants may be required to pay as much as $50,000 in civil penalties per violation, and treble damages.
  • Civil Monetary Penalties Law — This statute punishes several types of misconduct, including violating the Anti-Kickback Statute, making false statements on applications or contracts to participate in a federal health care program and submitting false claims to Medicare. Civil penalties range from $10,000 to $50,000 per violation.

Some violators may be excluded from participation in the Medicare program.

If you’re accused of any such violation, you need to promptly retain an attorney who is skilled and experienced in Medicare fraud defense. You might have a valid defense to the charges, perhaps even heading off civil and criminal penalties. If not, your attorney can negotiate a settlement that can save you a lot of money.

The Law Office of David Jay Glassman, with offices in Philadelphia, provides effective representation in Medicare fraud cases. Call us at 215-563-7100 or contact us online to schedule a free consultation.