Historic Medicare Fraud Takedown Names 73 from Florida, 16 from Michigan

In recent years, there has been a significant increase in the amount of Medicare fraud charges brought against physicians, home health care agencies, chiropractors, dispensaries, and pharmacists. This is largely due to the increase in enforcement.

The ACA bolstered the anti-fraud effort by pumping $350 million into fraud prevention and enforcement. The number of defendants from Miami continues to bolster the argument that Miami is the epicenter of Medicare fraud.

It’s important to note the combination of Anti-Kickback statutes, False Claims Act, and Stark laws provide the government with a powerful tool to cast a very broad net. 

While Anti-Kickback statutes require intent, the intent element is minimal, and non-existent with Stark and False Claims Act allegations. Combining these statutes with the OIG Civil Monetary Penalty (CMP) provisions and the Cooperate Integrity Agreement (CIA) penalty or total exclusion, provides the government with a powerful weapon to fight fraud.

Unfortunately fraud is a serious problem and whenever there is fraud it casts a shadow on the hundreds of thousands of health care professionals who are honest and do a good job following often very difficult conditions of payment established by CMS.

Health professionals charged with Medicare fraud face significant criminal penalties (5 years for each violation) and civil penalties ($25,000 fine per violation, treble damages, and penalties), plus potential exclusion from participation in billing any government program or placement on the corporate integrity watch list.

Health care law in general is stacked in layers and it changes weekly. A violation of one statute often triggers three, four, or more violations of other statutes as well as professional licensing actions and possible revocation and exclusion.