Dealing with Healthcare Fraud and Abuse: Penalties and Legal Action Possible

The federal government is increasingly concerned over the growth of healthcare fraud and abuse of privileges over the past few decades. Task forces, teams, and many programs have been put into place with the aim of prosecuting abuse and fraud. The Centers for Medicaid and Medicare Services say that they got $3.3 billion from providers involved in these offenses. Due to an increase in the scrutiny into abuse and health care fraud, healthcare professionals and providers in increasing numbers are facing criminal charges. It is time they realized the penalties that they could face if they are convicted.

 Leaders in risk management

As the leader in risk management, Digital Harbor offers end to end operational intelligence suits that help in detection, assessment, and monitoring fraud and risk. We help stakeholders and the relevant knowledge workers connect seamlessly both within and between institutions to help the relevant authorities make informed decisions to bring about effective risk management. Better management is possible if the relevant providers are made aware of the fines and penalties they could face.

 Penalties for fraud

If anyone found giving payments to others or taking or accepting kickbacks, or making fraudulent claims that are described under the False Claims Act, U.S. Department of Health and Human Services, Office of the Inspector General may assess health care fraud penalties of $50,000 for each violation and $11,000 for each false claim. Also, the officer of the Inspector General could levy an amount in damages as much as triple the amount that the government had to lose due to the fraud.

 Extent of penalties

The False Claims Act describes fraudulent claims and if anyone is convicted he or she may have to pay criminal fines as much as $250,000 and undergo 5 years in prison. Understandably, the criminal penalties for healthcare fraud such as knowingly submitting false Medicare claims are big. Similarly, under the Anti-Kickback Statute, if anyone is convicted, he or she may face 5 years’ incarceration and $250,000 in criminal fines. Other than that, there are civil fines that are considerably lower than these but nonetheless as binding.

 Exclusion of provider possible

Once the health care providers are convicted of felony fraud or Medicare fraud offenses, they will remain excluded from the healthcare services. A person or entity that is excluded in this manner is prevented from billing Medicare directly for any service or item. Failing to comply can lead to penalties that are more severe. This provision will limit the ability of the healthcare provider to work with or for parties those who are getting funding through federal healthcare programs. Qui tam action could be brought in specific situations and a reasonable amount of legal fees and expenses may be recovered.

Having worked and proven itself with the biggest intelligence agencies in the Government and the largest financial institutions of America, we now focus on the healthcare segment in the U.S. and have already given a saving of over $500 million in this segment. We are at the forefront of making first-of-its-kind technologies across many industries and also the first to create the links analytics platform.

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