When is Health Care Fraud Criminal?

samuel-zeller-360588-copy-200x300Those who are under investigation for health care fraud may face years in federal prison if they are found guilty, or they ay face civil charges that result in much less severe penalties. It is up to the discretion of the federal prosecutor to determine if the case will be criminal or civil. If you have come forward to report health care fraud, how do you know whether those you have turned in will face criminal or civil charges?

Types of Health Care Fraud

It can be helpful to understand some of the basic laws surrounding health care fraud. The following are come key laws that, when violated, can be result in serious consequences:

  • False Claims Act Violations: This is the main statute federal prosecutors will use when charging someone with health care fraud. Under the Act, a person found guilty of making false claims can face up to three times the amount of any money they wrongfully received. They may also face additional civil penalties.
  • Stark Law Violations: Stark Law prohibits any physician from referring a Medicare patient to an entity in which they have a financial interest. Violations for this include civil remedies of up to $15,000 per referral, and possible exclusion from Medicare completely.
  • Anti-Kickback Statute Violations: This statute prohibits healthcare professionals from offering something of value in order to obtain more referrals of Medicare or Medicaid business. Those found in violation face criminal penalties of up to five years in prison, as well as a fine up to $25,000.
  • Criminal health care fraud statute: Under 18 U.S.C. Section 1347, it is illegal for any person to defraud a healthcare benefit program or make false statements to obtain funds from a healthcare program.

If you suspect that your employer is engaging in unlawful healthcare practices, reach out to a California health care fraud whistleblower attorney today to guide you through the next steps.

When Health Care Fraud is Criminal

In many cases, the U.S. Attorney’s office will not indicate whether someone is facing civil or criminal charges. This is often because they may investigate someone for a civil violation, such as a breach of the False Claims Act. However, as their investigation continues, federal prosecutors may find the case also involves criminal penalties, depending on the circumstances. For example, if the investigation involves the IRS, grand jury subpoenas, or seizures of property, criminal charges will most likely apply.

Suspect Health Care Fraud? Contact a San Francisco Qui Tam Attorney

Health care fraud is a serious crime that impacts all U.S. citizens. Those who believe they know of someone committing health care fraud should reach out to a whistleblower lawyer in San Francisco for help. Contact Willoughby Brod, LLP today at (800) 427-7020. We are serious about providing you with the help you need to ensure that your rights are protected. No one should try to blow the whistle on their own. Contact us today for your free case evaluation.

Related Posts:

Most Common Types of Pharmaceutical Fraud

Key Distinctions Between the Anti-Kickback Statute and Stark Law

(image courtesy of Samuel Zeller)