Federal prosecutors stepping up efforts against Medicare fraud

Federal officials are increasing their efforts against healthcare fraud as demonstrated by recent crackdowns.

In recent years the U.S. Department of Justice and other federal agencies have significantly increased their efforts in combating Medicare and Medicaid fraud. As the Fiscal Times reports, in a single sweep last year the Federal Bureau of Investigation (FBI) laid criminal charges against 243 people in relation to allegations of Medicare fraud, the largest such crackdown in history. Furthermore, at the time of the sweep the FBI said it was investigating a further 2,700 cases of suspected health care fraud. The large number of arrests and investigations signals just how serious federal officials are treating health care fraud and why health care providers need to take the Medicare fraud crackdown seriously.

Extent of the crackdown

Analysts note that 2015 was the fifth year in a row that the federal government recovered more than $2 billion related to health care fraud, a figure that is even higher when including state recoveries of Medicare fraud. Such large amounts indicate that federal investigators are taking Medicare fraud increasingly seriously, as demonstrated in the large number of criminal charges that have been laid in recent years against those alleged to have engaged in fraudulent practices.

The federal crackdown against healthcare fraud is also reflected in a new rule the Centers for Medicare and Medicaid Services (CMS) recently proposed. According to Modern Healthcare, the rule would prohibit health care providers from Medicare and Medicaid funding if they work with somebody who has already been banned from the federal programs or who have debts with the federal government. The new rule comes after CMS recently started enforcing criminal background checks on health care providers who the federal agency considers at high risk for Medicaid fraud.

Consequences of fraud convictions

The federal crackdown against Medicare fraud should serve as a reminder of what is at stake when an individual is accused of such fraud. A conviction, for example, could lead to substantial fines, prison time and the loss of one's professional license. An accusation alone could be enough to seriously damage one's professional reputation within the community. In some cases negotiations between prosecutors and the defendant's attorneys may allow the defendant to avoid prison, but he or she could still be required to pay significant fines.

Medicare fraud defense

Medicare fraud cases are unique and differ substantially from other types of fraud cases. Unlike with many other fraud cases, for example, a Medicare fraud case may involve evidence relating to medical coding, unnecessary billing, computerized healthcare systems and medical necessity. Anybody who has been accused of health care fraud should reach out to a criminal defense attorney who is familiar with how such cases are typically handled. With an experienced attorney on one's side, defendants will have the representation they need to help uphold their futures and professional reputations.