From diagnosing potentially life-threatening conditions to performing complex surgical procedures, physicians often face intense performance expectations. Similarly, medical professionals frequently find themselves facing heightened scrutiny when it comes to potential charges of fraud.
In addition to steep fines, violating federal fraud laws may result in imprisonment, a prohibition on participating in federal health care programs and the loss of state medical licensure. In recent years, efforts in the U.S. to prosecute cases of potential fraud have increased, making it essential that doctors understand the consequences of a conviction.
- False Claims Act
Under the False Claims Act, a physician may face federal charges for submitting unjustified Medicare or Medicaid claims, falsifying patient medical records or providing incorrect medical billing information. Civil penalties for filing false claims may include repayment of three times the amount fraudulently received, a fine of $5,000 to $10,000 and an additional fine of $22,000 per claim filed. A criminal charge under the FCA may result in additional monetary penalties, imprisonment or both.
- Anti-Kickback Statute
Physicians who knowingly offer or accept payment in exchange for patient referrals or for the purchase or use of products, services or other items covered by Medicaid or Medicare may violate the federal Anti-Kickback Statute. Anything of value may constitute illicit remuneration, including cash, excessive compensation, expensive gifts or free or reduced rent for medical facilities.
A civil conviction under the AKS may result in forced repayment of up to three times the amount of remuneration as well as $50,000 per kickback, while a criminal conviction may lead to additional fines, imprisonment and a ban on participation in federal health care programs.
- Physician Self-Referral Laws
Under the Physician Self-Referral Laws, or Stark Laws, it may be a federal violation for a doctor to refer a patient for designated Medicare or Medicaid health services if the physician or a close family member may benefit financially. A prohibited financial relationship may include ownership or investment in the referred service or specific remuneration arrangements. Penalties may include a fine of up to $15,000 for each service in violation of the law and payment of three times the amount illicitly received.