It is illegal to defraud the federal government, but fraud in programs like Medicare is very common.

You may face investigation for Medicare fraud because of the actions of an employee. Now the False Claims Act comes into play, and your medical license is at risk.

Committing healthcare fraud

Healthcare fraud schemes appeal to individuals and groups of people alike. Medicare fraud happens frequently because there are many ways to engage in this kind of activity:

  • Submit false claims to obtain federal healthcare payments
  • Bill Medicare for appointments patients failed to keep
  • Bill for medical supplies or services not provided
  • Pay remuneration as a reward for referrals toward services for which federal healthcare programs will provide reimbursement

Running afoul of the FCA

The primary purpose of the False Claims Act, or FCA, is to protect the federal government and its programs from overcharges. Each service or item billed to Medicare counts as a single claim, so fines can multiply rapidly. Penalties for defrauding Medicare may include up to $11,000 per claim plus additional fines equal to three times the program’s loss. If, for example, employees responsible for billing in your office have filed fraudulent Medicare claims over a period of years, the program’s loss could be significant.

Determining your role

Specific intent to defraud a government agency is not required under the FCA. If an investigation shows that you knew or should have known that one or more of your employees was carrying out illegal billing activities, you could face criminal penalties, including time in prison. The act defines “knowing” as acting in “reckless disregard” or “deliberate ignorance” of the fraudulent activity. It is wise to take action to protect your interests as soon as you become aware that an investigation is imminent so that a defense strategy can immediately begin. The possibility of fraudulent activity in your office puts your professional license, your integrity and your future at stake.