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Is Medicare fraud a criminal offense?
Individuals or entities who commit Medicare fraud can be convicted of a felony. Felony is a criminal offense punishable by more than one year in prison. Medicare is a federal program, and defrauding the government and its program is illegal and can lead to criminal charges.
What happens if you suspect Medicare fraud?
If you suspect a fraud has occurred, you should report it, providing as many details as you can, in any of the following ways: Call Medicare’s help line at 800-633-4227. Call the Office of Inspector General directly at 800‑HHS‑TIPS (800‑447‑8477, or TTY 800‑377‑4950).
Does CMS identify and prosecute those who commit fraud?
CMS is working with law enforcement partners to investigate and prosecute alleged fraud. Medicare provides support and resources to the Medicare Fraud Strike Forces, which investigate and track down individuals and entities defrauding Medicare and other government health care programs.
What are possible penalties for Medicare fraud or abuse?
Penalties: Criminal penalties and administrative sanctions for violating the AKS may include fines, imprisonment, and exclusion from participation in the Federal health care program. Under the CMPL, penalties for violating the AKS may include three times the amount of the kickback.
How do you investigate Medicare fraud?
You can report suspected Medicare fraud by:
- Calling us at 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
- If you’re in a Medicare Advantage Plan, call the Medicare Drug Integrity Contractor (MEDIC) at 1-877-7SAFERX (1-877-772-3379).
What is an example of a Stark law violation?
Upcoding Medicare billings for E&M patient visits in order to obtain larger payments than allowable for the services actually provided. Billing for cardiac rehabilitation therapy provided by a physician who was not properly supervising the therapists providing the services.
Who enforces Medicare fraud?
Government agencies, including the U.S. Department of Justice (DOJ), the U.S. Department of Health & Human Services (HHS), the HHS Office of Inspector General (OIG), and the Centers for Medicare and Medicaid Services (CMS), enforce these laws.
How do you anonymously report Medicare fraud?
To report suspected Medicare fraud, call toll free 1-800-HHS-TIPS (1-800-447-8477).