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Is Medicare Fraud a Felony?

Medical fraud wording with stethoscope and gavel. Law concept

Medicare fraud is an extremely serious charge. If you or your medical practice is under investigation for or otherwise facing allegations of Medicare fraud, you need to act quickly to protect your rights, your practice, and your freedom. Depending upon the circumstances, you may face serious penalties including fines, license suspension, and even prison time. Read on to learn whether and how Medicare fraud can lead to felony charges, and if you are facing Medicare fraud allegations, call a zealous California Medicare fraud defense lawyer for advice and representation.

Criminal Medicare Fraud: Civil Liability, Misdemeanor, or Felony

Medicare fraud is a broad-brush term that encompasses a variety of conduct. Medicare fraud is chargeable when a defendant obtains money from Medicare under false pretenses. Medicare fraud can involve billing fraud or violation of several other statutes, including the Stark Law (Physician Self-Referral Law), the Anti-Kickback Statute, the False Claims Act, the Social Security Act, or the U.S. Criminal Code.

Perpetrators of Medicare fraud can face civil or criminal sanctions. Civil liability can lead to heavy fines, exclusion from Medicare, and treble damages. Criminal fraud can lead to prison terms. Criminal fraud typically requires a higher level of mental culpability (knowing or willful conduct) and carries a higher burden of proof (beyond a reasonable doubt).

In California, defrauding Medi-Cal or committing other forms of healthcare fraud can be charged as a misdemeanor or a felony, depending on the circumstances. Factors affecting the charging decision include the amount defrauded, the means used to do so, and the nature of the defendant’s specific conduct.

Federal Medicare fraud can be prosecuted as health care fraud under 18 U.S.C. § 1347, which is chargeable as a felony and punishable by up to 20 years in prison. Federal Medicare fraud may be charged as major fraud against the United States, a felony, or as a conspiracy, mail fraud, or wire fraud, as discussed below.

Conspiracy, Mail Fraud, Wire Fraud: Misdemeanor or Felony

In addition to the underlying fraud charges, a defendant charged with Medicare fraud may face several other criminal charges. An overzealous prosecutor could charge the defendant with conspiracy, mail fraud, or wire fraud, depending upon the means used to perpetrate the alleged fraud.

Mail fraud and wire fraud are both felonies with penalties ranging up to 20 years in prison for each count (or up to 30 years if the acts involved defrauding a financial institution). Mail and wire fraud are federal crimes, chargeable when an underlying fraud scheme was committed by way of the mail or interstate wire communications.

A defendant may also be charged with conspiracy. Conspiracy is chargeable under both state and federal law. To be guilty of conspiracy, the defendant must have entered into an agreement with at least one other person to commit a crime and performed at least one overt act in furtherance of that conspiracy (whether or not that overt act was criminal, so long as it furthered the conspiracy).

Under California law, conspiracy can be charged as a misdemeanor or a felony, typically based on the severity of the underlying criminal activity and the nature of the defendant’s conduct and participation in that conspiracy.

Conspiracy against the United States (which would include defrauding Medicare) is a federal felony, punishable by up to five years in prison. If the underlying crime was a misdemeanor, however, then the punishment cannot exceed the maximum punishment that the misdemeanor would have carried.

Call a California Medicare Fraud and Healthcare Criminal Defense Attorney for Help Defending Against Medicare Fraud Charges

For help responding to Medicare fraud or regulatory compliance issues, assistance with building your medical practice, or advice and representation concerning internal investigations, auditing, employment matters, governance issues, business disputes, licensing, or any other California healthcare law matter, contact the Law Offices of Art Kalantar in Los Angeles or California statewide at 310-773-0001.

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