Over 50 Years’ Combined Experience
Health Care Fraud Charges & Sentencing - 18 USC 1347
Healthcare fraud involves healthcare providers or organizations billing for services or products that were not provided, or for services or products that are not medically necessary. This type of fraud can take many forms, including billing for unnecessary procedures, double-billing, upcoding, kickbacks, and falsifying medical records. Healthcare fraud can have serious consequences, including financial losses for patients and insurers, decreased quality of care, and the potential harm to patients who receive unnecessary or harmful treatments.
It also undermines public trust in the healthcare system and wastes valuable healthcare resources. To combat healthcare fraud, the United States government has established various regulatory frameworks, including the False Claims Act, the Anti-Kickback Statute, and the Physician Self-Referral Law (also known as the Stark Law). These laws make it illegal for healthcare providers to engage in fraudulent activities and provide penalties for those who do.
Penalties for healthcare fraud can include fines, imprisonment, exclusion from federal healthcare programs, and revocation of licenses. The severity of the penalties depends on the scope and nature of the offense. In addition, healthcare providers found guilty of fraud may be required to pay restitution to patients and insurers for any financial losses incurred.
To prevent healthcare fraud, individuals and organizations must be vigilant in monitoring their healthcare bills and reporting any suspicious activity to the appropriate authorities. By working together, healthcare providers, insurers, and patients can help to combat healthcare fraud and protect the integrity of the healthcare system.
Who Investigates Healthcare Fraud
Healthcare fraud is investigated by various government agencies, including the Department of Justice (DOJ), the Department of Health and Human Services (HHS), OIG Office of the Inspector General and the Federal Bureau of Investigation (FBI). These agencies work together to investigate and prosecute healthcare providers and organizations suspected of engaging in fraudulent activities. In addition, whistleblowers can report healthcare fraud to the government through the False Claims Act, which provides financial incentives for reporting fraud.
Penalties for Healthcare Fraud
The penalties for healthcare fraud can be severe, including fines, imprisonment, exclusion from federal healthcare programs, and revocation of licenses. The penalties vary based on the scope and nature of the offense, but can be as high as $500,000 in fines and up to 10 years in prison for individuals, or $1 million in fines for organizations. In addition to the criminal penalties, healthcare providers found guilty of fraud may be required to pay restitution to patients and insurers for any financial losses incurred. The severity of the penalties underscores the importance of preventing and deterring healthcare fraud to protect the integrity of the healthcare system.