Michigan Health Care False Claims Act
Michigan Criminal Defense Attorneys
The Michigan Health Care False Claims Act criminalizes committing fraud in order to acquire health care payments or benefits through channels associated with health care coverage. With around 100 years of combined experience, The Kronzek Firm’s trial team is the right choice to aggressively defend you in any fraud related case. As our track record illustrates, we have defended and won countless felony and misdemeanor cases.
Under Michigan Law, an individual cannot submit, or cause to be submitted, a claim, known to be false, to a health care insurer or corporation for payments of health care benefits.
Medically Unnecessary Claims
Also, a person cannot present, or cause to be presented, a claim for health care benefits to a health care insurer or corporation when he or she knows it falsely states that the services or supplies were medically necessary. Health care agencies or facilities are not liable under this section unless, as part of a conspiracy or collusion with a doctor, the entity falsely states the medical necessity of the services or goods upon which the claim was based.
Individuals are likewise prohibited from knowingly making, or causing to be made, a false statement or false representation of a material fact to a health care corporation or insurer in order to determine rights to health care benefits.
A person with knowledge of an event that affects his or her initial or ongoing right to obtain a health care benefit—or that of another if applying for or receiving benefits on behalf of another—cannot conceal or omit disclosure of that event in order to receive unentitled or greater benefits.
A person in violation may be charged with a felony with a maximum penalty of four years in prison, a fine up to $50,000.00, or both.
Kickbacks and Bribes
An individual who offers, pays, solicits, or obtains a bribe or kickback connected with providing services or goods for which payment is made by a health care insurer or corporation, or receives a reduction of a fee for referring a person to somebody else for the furnishing of benefits, may be charged with a felony with a maximum penalty of four years in prison, a fine up to $50,000.00, or both.
A person may not engage in a conspiracy to defraud a health care organization or aid another in submitting a false claim for benefits. This is a felony with a maximum penalty of 10 years in prison, a fine up to $50,000.00, or both.
Second or Subsequent Offense
Individuals convicted of second or subsequent offenses may be subject to an increased sentence, fined up to twice the amount authorized, or both.
A rebuttable presumption exists that a person knowingly made a claim for benefits if a person’s signature in one of the various valid types is on the applicable required claim form. If a claim is made through electronic means, there is a rebuttable presumption that the person knowingly made the claim if he or she alerted the health care insurer or corporation in writing that claims for benefits will be submitted through electronic means.
Liability to Health Care Corporation or Insurer
An individual who receives health care payments or benefits from a health care insurer or corporation, knowing that he or she is unentitled, or a person who knowingly presents a claim containing a false statement, is liable to the health care insurer or corporation for the entire amount of the payment or benefit received.
If a person is convicted of certain health care fraud offenses, he or she may be ordered to make restitution to the health care insurer or corporation. This is in addition to any other sentence, fine, or probation imposed.
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Call The Kronzek Firm at (866) 7-NoJail. We offer a free, immediate consultation to individuals throughout the Lower Peninsula who are considering obtaining our services.
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