7 Potential Penalties of a Medical Fraud Conviction

Medical fraud undermines the integrity of the healthcare system, diverting resources away from legitimate needs. For that reason, the consequences can be severe for those convicted of medical fraud. Here’s some insight from medical fraud attorneys on the potential repercussions of medical fraud.

7 Potential Penalties of a Medical Fraud Conviction: Thoughts from Medical Fraud Attorneys

Criminal Fines

Depending on the severity of the offense, convicted individuals can face significant criminal fines. Federal statutes, like the False Claims Act, carry maximum fines of $250,000 per violation. In some cases, fines can be tied to the amount of money gained through fraudulent activity, potentially reaching millions of dollars.

Civil Fines

Beyond criminal penalties, perpetrators may also be subject to civil fines imposed by government agencies. The Centers for Medicare & Medicaid Services (CMS) can levy substantial fines for violations of healthcare program regulations, reaching tens of thousands of dollars per claim.

Restitution

Courts may also order convicted individuals to pay restitution to the defrauded parties. This could include reimbursing government healthcare programs, insurers, or even patients for services not legitimately rendered.

Loss of Professional License

Depending on the specific offense and state regulations, a conviction may lead to probation, suspension, or revocation of a medical license. A convicted medical professional may be placed on probation, allowing them to continue practicing under strict monitoring and with limitations. A medical license can also be revoked by state licensing boards, effectively barring the individual from practicing medicine. These consequences can significantly impact a medical professional’s livelihood and ability to rebuild their reputation.

Jail Time and Imprisonment

Medical fraud is a serious crime, and depending on the circumstances, it can result in jail time or even imprisonment. Federal statutes associated with healthcare fraud carry maximum sentences ranging from several years to life, particularly in cases where the fraud resulted in serious bodily harm or death.

The length of any potential prison sentence will be determined by several factors. The amount of money involved in the fraud scheme is a key consideration for a decision on sentencing. Other key factors are whether the fraud resulted in patient harm, and the nature and severity of the fraudulent activities. Any prior criminal history of the convicted individual is a significant consideration as well.

Exclusion from Federal Healthcare Programs

A medical fraud conviction can lead to exclusion from participation in federal healthcare programs like Medicare and Medicaid. This can significantly impact a healthcare provider’s ability to operate and treat patients covered by these programs. The duration of exclusion can vary based on the severity of the offense. An attorney experienced in medical fraud is the best support in wading through these complexities. For more information, click here.

Difficulty Obtaining Future Employment

A medical fraud conviction can inflict lasting damage on an individual’s reputation. The negative publicity associated with a conviction can erode public trust and make it difficult to rebuild a career in the healthcare field. Even beyond the healthcare industry, a medical fraud conviction can create significant barriers to obtaining future employment. Background checks often reveal criminal records, and potential employers may be hesitant to hire someone with a history of fraud.

Medical fraud is a serious offense with far-reaching consequences. Understanding these penalties can serve as a strong deterrent and encourage all stakeholders to prioritize honest and responsible practices within the healthcare system.