Medicare is a government program that was established to help seniors and disabled individuals in Florida and the rest of the country afford healthcare. Unfortunately, it doesn’t cater to all seniors and disabled individuals. The government has placed strict rules and guidelines on individuals that can qualify for Medicare. This has resulted in many people finding illegal or creative ways to get around these rules to receive benefits.
Understanding Medicare fraud
Medicare fraud occurs when someone deliberately misleads or lies to the government to receive benefits they aren’t entitled to. This can be done in several ways, including, but not limited to:
- Billing for services that weren’t rendered
- Upcoding (billing for a more expensive service than what was actually provided)
- Unbundling (billing for a group of services separately when they should be billed together)
- Misrepresenting the diagnosis to justify certain treatments or tests
- Ordering unnecessary tests or procedures
Possible penalties for Medicare fraud
Medicare fraud is among the white-collar crimes that the federal government prosecutes. If you’re convicted of this crime, the amount of money you misappropriated will determine the severity of your penalties. For example, if you’re convicted of fraudulently billing Medicare for $50,000, you could face a first-degree felony charge with a prison sentence of up to 30 years and fines that are five times the value of the fraud. A second-degree felony (a fraud of $10,000 to $50,000) could be punished by 15 years in prison with fines, and a third-degree charge, which is a fraud value of $10,000 or less, could lead to up to five years in prison.
If you’ve been accused or charged with Medicare fraud in Florida, it’s important to understand the circumstances of your case to find appropriate defenses to use. For example, you can argue that you didn’t have the intent to commit fraud. Your criminal defense attorney can prove this by showing that you didn’t know they were committing fraud or that you reasonably believed you were entitled to the benefits they received. Another defense is that the government made a mistake in its investigation. This can happen if the government has misinterpreted billing codes or misidentified the services rendered.