What Are The Penalties For Health Care Fraud?


Doctors and health care providers of all kinds must be vigilant to avoid even the appearance of billing fraud. These white collar crimes are taken very seriously by the government, and it’s necessary to enlist the services of an experienced in attorney in Newark if charges are filed.

According to the Economist, “Federal prosecutors had over 2,000 health-fraud probes open at the end of 2013. A Medicare ‘strike force’, which was formed in 2007, boasts of seven nationwide ‘takedowns’. In the latest, on May 13th, 90 people, including 16 doctors, were rounded up in six cities—more than half of them in Miami, the capital city of medical fraud.”

Newark is far away from Miami, but the Law Offices of Robert J. Degroot still have many years experience providing strong defenses for health care providers accused of fraud or abuse.

According to Blue Cross Blue Shield, these are the most common reasons why a provider may be charged with health care fraud:

  • Billing for services that were not provided.
  • Duplicate submission of a claim for the same service.
  • Misrepresenting the service provided.
  • “Upcoding” – charging for a more complex or expensive service than was actually provided.
  • Billing for a covered service when the service actually provided was not covered.

It’s important that every health care provider have a full understanding of the penalties they may face if convicted of these charges. Especially in situations where they may not be directly involved with the medical billing process on a day-to-day basis.

Potential Penalties For Health Care Fraud Charges

Prison Time

Providers who are convicted of making a misleading statement or false claim to Medicaid or Medicare can face up to five years in prison per offense, while federal health care fraud convictions can carry up to a 10-year prison sentence for each offense. In the case that fraud results in the bodily injury of a patient or employee, the potential prison sentence skyrockets to 20 years, while a case that results the death of another person can in turn result in a life sentence.

Costly Fines

In addition to prison time, a health care fraud conviction carries stiff fines. False claims or statements made to Medicaid or Medicare by an individual can carry up to $250,000 in fines per offense, while an organization convicted of these same offenses can face up to $500,000 in fines per offense.


Sentencing for a health care fraud case can take many different forms. In addition to prison time and fines, those involved may also be ordered to make restitution for their offenses. This means profits obtained illegally must be returned to the insurance company.


In cases that don’t warrant prison time, a judge may decide to instead sentence an offender to probation. While it provides more freedom than life in a prison cell, probation may last one to three years and requires regular meetings with a probation officer, constant employment, and absolutely no commission of other crimes’

In order to avoid these life-altering penalties, anyone accused of medical fraud needs to seek the services of a white collar attorney immediately. If you’re in Newark, the Law Offices of Robert J. Degroot is ready to help.