Go to navigation Go to content
Toll-Free: 888-733-2992
Phone: 605-361-9840

A Medicaid or Medicare Fraud Conviction Could Result in Serious Penalties

Jeff Cole
Connect with me
Partner at Zimmer, Duncan & Cole

If you have been charged with Medicaid or Medicare fraud, you are facing serious federal charges that could have long-term consequences for your life. Because Medicaid and Medicare claims are paid from the taxes of citizens, the federal government is aggressive in investigating and prosecuting those suspected of fraudulently making claims. Many in the healthcare industry could be charged, including the following:

  • Healthcare providers such as doctors, nurses, home healthcare providers, physical therapists, and pharmacists
  • Vendors of healthcare goods such as wheelchairs, walkers, and other healthcare equipment

Five False Claims That Could Result in Charges for Medicare and Medicaid Fraud

Under the False Claims Act, it is illegal to submit false claims for reimbursement to Medicare, Medicaid, and other government healthcare programs. Common types of false claims include the following:

  • False billing. One of the most common types of fraud involves billing for services, procedures, or supplies that were not provided. It can also include charging for higher-priced products or services than were supplied.
  • Billing for unnecessary services. Medicare and Medicaid only pay for services and items that are “medically reasonable and necessary.” When claims for reimbursement are made for unnecessary tests, procedures, or services, they could be considered false claims.
  • Offering or accepting kickbacks. Under the Anti-Kickback Statute, healthcare providers are prohibited from paying or receiving anything of value for referring patients under Medicaid or Medicare. Violation of this law also constitutes a false claim.
  • Unbundling claims. This involves using two or more billing codes rather than one that’s more inclusive or submitting multiple bills which should have been submitted as one bill in order to receive higher compensation.
  • Prescription fraud. People commit prescription fraud when they illegally give out or obtain prescriptive drugs, sell drugs to people without a valid prescription, modify a prescription to obtain a higher dosage or quantity of the drugs, or forge a prescription. Addictive narcotics are often involved.

Penalties for Medicaid and Medicare Fraud

Penalties for this crime vary, but if charged with Medicaid or Medicare fraud, you could face the following:

  • Up to 10 years in prison if no injuries or deaths were associated with the fraud
  • Up to 20 years in prison if the fraud involved serious injuries
  • Life imprisonment if the fraud resulted in the death of a patient
  • Hefty fines

If you are being charged with Medicare or Medicaid fraud, you need to speak to an criminal defense attorney who understands the federal criminal law process. Call us today at 888-733-2992 to schedule a free consultation. We’ll explain the charges against you and how we can help you obtain the best possible outcome in your criminal matter.


  • Observer
  • The Lennox Independent
  • Tea Weekly
  • AlcesterUnion & Hudsonite
  • The New Era
  • SuperLawyers