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What is Medicare fraud?

On Behalf of | May 8, 2023 | Criminal Law

Millions of Americans in the U.S. receive healthcare coverage through Medicare, which is the federal health insurance program for those who are over the age of 65. Although this federal program provides a necessary service to many, the Medicare program is the target of fraud on a regular basis.

According to CNBC, Medicare fraud in the U.S. totals an estimated $100 million on an annual basis, but some suspect this number is much higher. This type of fraud occurs when someone receives payment or receives a higher payment than he or she should by deceiving the Medicare system.

Examples of Medicare fraud

Medical providers, individuals and organizations can all commit Medicare fraud. For example, if a provider bills the Medicare system for supplies and services never used, this is an example of Medicare fraud. If a provider bills the Medicare system two times for a service only provided once, this is another example of fraud.

An individual can commit Medicare fraud if he or she uses a Medicare card or number to submit fraudulent claims. And an organization can commit Medicare fraud by offering a prescription drug plan not approved by Medicare.

Penalties for Medicare fraud

The penalties for committing Medicare fraud vary depending on the alleged crime. For instance, according to the U.S. Department of Health and Human Services, filing a false claim can result in an $11,000 fine for the claim filed in addition to a fine totaling three times what the program lost.

The consequences of committing Medicare fraud can go beyond fines. Those who currently face charges for committing Medicare fraud should take steps to protect their legal and financial interests.


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