In 2016, three owners of 30 skilled nursing and assisted living facilities in Florida was involved in biggest ever medical fraud that netted him about $1 billion since 2009. This is a single indication of the depth of fraud in the medical industry, which is one of the most regulated industries in the United States. As such, fraudsters are usually met with hard retribution and verdicts that put their companies and assets at risk. But today, legal help can help with making the whole process of a fraud case as feasible as possible.
Distinguishing Medical Fraud from Mere Mistakes
Typically, a fraud is a scheme that the alleged participants knowingly provide falsehood with the intent of achieving a financial gain. It is not a situation whereby a mistake is made, resulting in the patient getting billed in excess or for a service he or she did not get. By contrast, a fraud happens when a health care provider offers treatments or procedures that he or she knows the patients do not need, and then levies the insurer to make profits.
Penalties for Medicare Fraud Cases
Fraud cases attract varied penalties depending on the severity of the case. Therefore, it is important to work with legal professionals to understand how such class actions could eventually fall.
Medicare fraud cases are serious offenses and can attract a lengthy imprisonment. Cases that relate to Medicare can result in up to 5 years in prison per offense. Cases that result in body injury to a patient have a potential of 20 years while one that causes death attracts life imprisonment.
In some cases, the judge may order the defendants to pay back the money the solicited illegally and fraudulently from the victims. Typically, any amount that was improperly obtained as a result of the fraudulent activity is to be paid. Also, the restitution may include a government fine.
In Medicare fraud cases, the court may impose fines of up to $250,000 on individuals who get involved in fraud. Organizations that engage in fraud risk up to $500,000 per offense. For those involved in fraud schemes, the fines can be quite hefty, reaching up millions or billions of dollars. Typically, it depends on the period for the fraud and the extent of the activities.
For some Medicare fraud cases, an individual may face a probation which may last up to 12 months. In such cases, the probations inhibit and limits the freedoms of the defendant. The defendant does no receive a jail term. However, some probations can last up to even three or more years. During the probation, the individual must comply with specific regulations and instructions and meet with a probation officer regularly.
For these scenarios, it is necessary to have a pre-litigation strategy to avoid a harsher verdict. A person may need a supervision of claims administrator to determine the best approach to handling each offense. Some cases may also demand international investigations to determine the scope of the scheme that judges may need to give a final verdict during a trial.
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