The medical industry is closely watched and heavily regulated. Because healthcare fraud costs billions of dollars each year, federal and Texas authorities, along with insurance companies, spend a lot of time and resources investigating and prosecuting suspected fraud.
People and companies accused of healthcare fraud can face civil penalties, criminal charges, or both. Understanding Medicare and Medicaid fraud, and what happens if you are convicted can have a major impact on your future.
The Difference Between Medicaid and Medicare
Medicare is federal health insurance for people age 65 and older, and for some younger people with certain disabilities or medical conditions. Medicaid is a state and federal program that offers medical coverage for people with low incomes and limited resources.
People on Medicare usually pay part of their medical costs, such as deductibles, co-pays, and monthly premiums. People on Medicaid usually pay little or nothing for covered care, though they may have small co-pays for some services.
What Are Medicaid and Medicare Fraud?
Medicare or Medicaid fraud occurs whenever a company or a person knowingly sends fake bills to either of these programs. This can include billing for services that were never provided, billing for unnecessary care, or taking money for sending patients to specific providers.
How Is Healthcare Fraud Committed?
Medicare and Medicaid fraud can be committed by many different people or businesses, including doctors, healthcare providers, suppliers, and sometimes patients. Common types of Medicare and Medicaid fraud include:
- Billing for services never given: Charging for care that did not happen
- Overbilling: Charging for a more expensive service than was provided
- Billing services separately: Charging separately for services that should be billed together
- False provider claims: Billing as if a licensed provider gave the service when they did not
- Kickbacks: Getting paid for sending patients to certain providers
Why is Healthcare Fraud Such a Huge Problem?
Medicare and Medicaid fraud are major problems because they cost taxpayers a lot of money. Each year, taxpayers lose more than $100 billion due to fraud in these programs.
Fraud can also hurt patients. People may receive poor care or treatments they do not need, such as unnecessary medicine or surgery. Fraud also raises healthcare costs and can make it harder for people who truly need care to get it.
Penalties for Medicaid and Medicare Fraud
Medicare and Medicaid fraud are weighty crimes that carry harsh penalties. Healthcare providers who commit fraud can face large fines, jail time, and a ban from Medicare and Medicaid. They may also have to pay money back to the government. Patients can also be punished for fraud. For example, a patient who takes money or gifts for getting treatment can be charged with a crime.
Steps to Take if You’re Accused of Medicaid or Medicare Fraud
An accusation of healthcare fraud is serious and can have lasting effects on your life. If this happens, it is important to act quickly to protect your rights and reduce the damage.
Here are some things to keep in mind if you are convicted of Medicare or Medicaid fraud:
Work With an Experienced Federal Healthcare Fraud Attorney
The first step is to hire a lawyer who has experience with healthcare fraud cases. A skilled federal healthcare fraud attorney can explain your options and help you plan the best way to defend yourself.
Cooperate With the Investigators
Cooperating with investigators is essential if you are accused of Medicaid or Medicare fraud. In fact, being uncooperative could even result in additional charges and penalties. Your attorney will ensure that you understand the investigation process and that your rights are protected.
Brace for Sentencing
If you are convicted of Medicare or Medicaid fraud, a judge will decide your sentence. It is important to prepare by collecting information that helps your case and showing that you are willing to repay any money lost because of the fraud.
Understand Your Options for Filing an Appeal
If you are convicted of healthcare fraud, you may be able to appeal the decision. A lawyer can review your case and help you decide if an appeal is worth pursuing.
If you or someone you care about has been accused of Medicare or Medicaid fraud, the first step is to speak with an experienced lawyer about your options. Aaron L. Wiley Law, P.C., focuses on criminal defense and can help.
Aaron L. Wiley Law, P.C.
Healthcare fraud cases are serious and can affect your freedom, career, and future. If you have been accused of Medicaid or Medicare fraud, or are under investigation and potentially facing charges, call Aaron L. Wiley Law, P.C. today at (254) 566-3860 or fill out our online contact form to speak with a federal healthcare fraud attorney and get clear, trusted legal help.