What Are the Penalties for Medicare Fraud in Pennsylvania?
Find Out (For Free) Why Pennsylvania Healthcare Providers Want Oberheiden, P.C. On Their Team: 888-680-1745
It’s not easy anymore to be a doctor in Philadelphia or Pittsburgh. You want to do right, help patients, improve lives—before you learn that federal prosecutors from the U.S. Attorney’s Office in Philadelphia are after you. In fact, most recently, the United States Justice Department declared Pennsylvania one of the key locations to combat Medicare Fraud and installed the Medicare Fraud Strike Force in Philadelphia to increase and expand on healthcare fraud prosecutions. If anything, things are only about to get worse for doctors.
Oberheiden, P.C. is unlike other law firms. We truly are. We focus our practice on defending healthcare providers and business owners and, in hundreds of federal healthcare cases, we have demonstrated that this special attention works. We don’t take drunk driving cases, we won’t assist you in legal problems other than protecting you, your license, your freedom when under investigation by the Pennsylvania FBI, OIG, and Justice Department for alleged Medicare Fraud, Medicaid Fraud, kickback allegations, False Claims Act matters and the like. Call us today and see for yourself what a difference experience can make in defending you against possible charges or penalties for Medicare Fraud in Pennsylvania. We have successfully represented:
- Mobile Ambulance Transportation Cases
- Mobile Radiology Services
- Home Healthcare Agency (Form 485 Cases)
- Hospice Care Representation
- Illegal Kickbacks
- Any Form of Medicare Fraudulent Billing
- Mental Healthcare Providers
- Dialysis Centers
- Family Medicine Doctors
- Internal Medicine Specialists
- Pain Management Doctors
- Medicare Clinic Owners
What Are the Penalties for Civil Medicare Fraud in Pennsylvania?
Federal prosecutors in Pennsylvania employed by the U.S. Attorney’s Office in Philadelphia and Pittsburgh prosecute Medicare Fraud as civil and criminal matters. Most civil cases begin with a subpoena from the Office of Inspector General requesting the production of patient files, corporate documents, and financial information. If this happened to your business, be aware that many civil fraud cases originate from whistleblower investigations, who, incentivized by money, report alleged fraud to federal authorities and file a federal civil complaint in court.
If not represented appropriately, your practice can quickly reach the stage of bankruptcy in such a case. Effective defense against penalties ranging from the tens of thousands of dollars for a single submission of a false claim requires a mastery and understanding of healthcare laws and federal defense experience.
Oberheiden PC lawyers have defended clients against civil fraud allegations in almost the entire United States. Call us at 888-680-1745 and see how we would protect your business and your monies.
What Does the Government Have to Prove in Pennsylvania Medicare Fraud Cases?
Medicare Fraud is a classic federal healthcare law offense. Criminal statute 18 U.S.C. 1347 explains that a person is guilty of healthcare fraud in Philadelphia federal court if the government can prove beyond a reasonable doubt that the following elements exist:
- The defendant knowingly and willfully executed or attempted to execute a scheme to defraud a healthcare benefit program or obtain money or property from a healthcare benefit program by means of false or fraudulent pretenses, representations, or promises;
- The defendant executed or attempted to execute the scheme or plan in connection with the delivery or payment of benefits, items or services under the healthcare benefit program; and
- The defendant acted with the intent to defraud the healthcare benefit program.
Because healthcare fraud and Medicare fraud are federal offenses, violations are typically investigated by Philadelphia-based federal law enforcement agencies such as the Federal Bureau of Investigation (FBI), the Office of Inspector General (OIG), the New Jersey Medicaid Fraud Control Unit (MFCU), and prosecuted by Assistant United States Attorneys from the U.S. Attorney’s Office in Philadelphia or Pittsburgh.
What Are the Penalties for Criminal Medicare Fraud in Pennsylvania?
A defendant guilty of Medicare fraud in Pennsylvania, and all other states, will be ordered to not more than 10 years imprisonment per count, a term of supervised release, criminal fines; asset forfeiture, and a mandatory special assessment. In healthcare cases, the exact penalty depends on the alleged damage amount and the calculated sentencing recommendations based on the Federal Sentencing Guidelines. Avoid these consequences, call 888-680-1745.
- Five doctors in Pennsylvania were indicted for their roles in a scheme to defraud Medicare. According to the indictment, the doctors worked as contractors at various pain management clinics in Pennsylvania and were prescribing medically unnecessary drugs. The doctors would then allegedly bill Medicare for reimbursement for the unauthorized prescriptions. If convicted, each doctor could face a maximum of 10 years in prison.
- A man in Pennsylvania was indicted for his role in a scheme to defraud Medicare. The man owned an ambulance transport company and would allegedly bill Medicare for patient transports when the patients were not eligible to receive such transports. According to the indictment, the man used his ambulances to transport dialysis patients who could walk and would create fake run sheets that suggested the patients were bedridden. The cost of the medically unnecessary transports was then billed to Medicare for reimbursement. As a result of the scheme, Medicare paid $5.5 million based on the fraudulent transports.
- A medical device company in Pennsylvania has agreed to a monetary settlement with the United States to settle allegations that it was defrauding Medicare. The medical device company was alleged to have been providing kickbacks to Durable Medical Equipment (DME) companies in exchange for the DME companies selling the device company’s sleep apnea mask. The device company would provide free services to the DME company as long as the DME company exclusively sold the device company’s mask. If the DME company did not exclusively sell the device company’s mask, the DME company would have to pay a monthly fee to the device company. As a result of the settlement, the device company will pay $34 million to resolve the allegations. Since the device company agreed to settle, there is no finding of liability.
- A healthcare corporation headquartered in Pennsylvania has agreed to settle with the United States for its alleged role in defrauding Medicare. The healthcare corporation allegedly billed Medicare for medically unnecessary services relating to services provided at its Long Term Care Hospitals (LTCH). The corporation would certify patients for long term care when these patients were not qualified to receive such care. The corporation is also alleged to have ignored its own clinicians’ recommendations and would keep patients in long term care even when a physician recommended discharging the patient. The services provided to patients who were not eligible to receive long term care were billed to Medicare for reimbursement. As a result of this settlement, the corporation will pay $32 million back to Medicare.
- A federal jury in Pennsylvania convicted a nurse of healthcare fraud for her role in billing fraudulent services to Medicare. Evidence at trial showed that the nurse was a director at a home health agency and would provide skilled nursing services to patients who were not eligible to receive home health services under the Medicare guidelines. These services were then billed to Medicare as if they were medically necessary. The jury convicted the nurse of four counts of healthcare fraud.
If you have any questions or concerns or need to better understand the penalty calculation for Medicare Fraud in Pennsylvania or need to get guidance for an upcoming sentencing hearing—then call Oberheiden PC today for a free and confidential consultation. We are available on weekends. Avoid these consequences, call 888-680-1745.