What is Medicare fraud?

On Behalf of | Apr 17, 2023 | White Collar Crimes |

If you are over the age of 65, you can use the federal health insurance program, Medicare. The Medicare system provides healthcare insurance to millions of U.S. residents and Medicare fraud occurs frequently.

According to CNBC, estimated fraud through the Medicare system amounts to an estimated $100 billion every year. Medicare fraud occurs when you intentionally provide the Medicare system with untrue information in order to receive unauthorized payments or benefits.

Examples of Medicare fraud

Medical providers, suppliers and recruiters, insurance brokers, pharmacists and medical companies or practices can all commit Medicare fraud. For example, a physician may commit Medicare fraud by submitting claims for services not provided or for unnecessary services. An insurance broker can commit Medicare fraud if he or she enrolls a client into a Medicare Advantage plan without first acquiring proper consent.

Penalties for Medicare fraud

The penalties you face for committing Medicare fraud depend on the type of fraudulent scheme committed. For instance, if you created false records, engaged in fraudulent medical billing or submitted false medical claims, you could face penalties under the False Claims Act. Or, if you receive kickbacks through the Medicare system in return for referrals, you could face charges under the Anti-Kickback Statute.

Regardless of what type of Medicare fraud activity you engaged in, the penalties for this type of white-collar crime can be severe and can include anything from heavy fines to time in jail. If you face charges for allegedly committing Medicare fraud, take legal action to protect your interests and defend your rights.