Welcome back and thanks for joining us here at The Kronzek Firm for our series on fraud in Michigan. Because fraud crimes are so varied, and there’s no way to sum them all up in one blog article. Therefore, we have decided to break it all down into a series that we hope will answer some of your questions and explain a few important details.
If you’re only joining us now, you may want to take a moment to go back and check out the previous articles in this series, starting with credit card fraud and covering many topics all the way through insurance fraud. For those of you who’ve been with us from the beginning, let’s hit the road.
What is health care fraud?
Health care fraud is when an individual or a company defrauds an insurer or government health care program, like Medicare. Health care fraud can include health insurance fraud, drug fraud, and medical fraud. It can be a state crime, a federal crime or both.
What are examples of health care fraud?
Health care fraud is usually perpetrated by doctors and physicians. It could include any of the following situations:
When a doctor:
- bills a health insurance provider for appointments a patient failed to keep
- makes a false claim in order to receive financial compensation for services and/or supplies they didn’t provide to patients
- Knowingly bills for more complex services than what was actually provided to the patient
- Pays for referrals of Federal health care program beneficiaries
What laws govern health care fraud?
According to the FBI, health care fraud costs the country billions of dollars every year, which is why so much time, energy and resources are dedicated to finding and eradicating it. The FBI also warns that sometimes civilians are the victims of health care insurance fraud, as their private information is accessed and used or sold.
Because of how extensive and costly health care fraud is, the federal government has numerous laws in place making all types of health care fraud illegal. These include:
- False Claims Act (FCA)
- Anti-Kickback Statute (AKS)
- Physician Self-Referral Law (Stark Law)
- Social Security Act
- United States Criminal Code
In addition, Michigan also has laws governing the conduct of medical professionals in order to ensure that the health care system isn’t abused. This includes the Michigan Health Care False Claims Act, which makes it illegal for any Michigan physician to make false claims, make medically unnecessary claims, accept kickbacks, conceal information or make false statements.
What is the penalty for health care fraud in Michigan?
Health care fraud is taken very seriously, both by the state of Michigan prosecutors and by the federal government. People found guilty of health care fraud in Michigan are facing the possibility of up to four years in prison, a fine up to $50,000.00, or both under state law.
Under federal law the penalties are even more severe, and can range, depending upon which law a person is accused of breaking. Under federal law, the maximum penalty is 10 years in prison and a fine up to $250,000. If the crime results in bodily injury to a victim, the maximum penalty is 20 years in prison. In cases of death, the maximum penalty is life imprisonment or any term of years.
Under the federal Social Security Act, anyone guilty of making false statements or representations in applications for payments or benefits could face up to five years in prison, a fine up to $25,000.00, or both. In addition, anyone offering, paying or accepting kickbacks is guilty of a felony and could face up to five years in prison, a fine up to $25,000.00, and exclusion from federal health care programs for up to a year.
What do I do if I’m accused of healthcare fraud?
Our answer for this question is the same as it would be for someone accused of any other serious crimes in Michigan – call The Kronzek Firm immediately at 866 766 5245. Health care fraud is a very serious crime, and whether you are facing charges from the state of Michigan or the federal government, we can help you fight for your future. So don’t wait, and don’t hope this will “blow over” because it won’t! Call us right now, before you do anything else, and speak with an experienced health care fraud defense attorney today. You can email us 24/7 at: Attorneys@kronzek.law.