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What Are the Potential Penalties for Health Care Fraud and Abuse?

Health Care Fraud

The federal government has been putting in place measures to ensure there is a reduced number of health care fraud and abuse cases. This is due to the increased cases of health care fraud in the past few years. The government has provided education and training to the health care providers to inform them of the various fraud they should not be part of. The government has also put in place laws and measure to help penalize those found guilty. Many people, providers and consumers, have been penalized for health care fraud and abuse. When you are suspected of health care fraud, you have the right to a health care fraud attorney. When found guilty, below are the penalties you make get.

When found guilty of health care fraud and abuse, you can be penalized with exclusion. This is whereby you are prevented from the direct billing of health care products and services. This also includes being banned from working with or having a contract in health care programs provided by the federal government. Exclusion is for a certain period of time. However, when you violate the penalty during the period, you may face an extent in the period of exclusion.

  • Being charged with fraud.

When the case is strong, you may be charged with fraud by the federal court when found guilty of health care fraud and abuse. This is a serious penalty and you may end up in prison. Therefore, when faced with federal investigations concerning healthcare fraud, it is advisable to consult a health care fraud attorney to reduce your chances of being charged with fraud. Whether you are innocent or not, you should ask for an attorney.

Fines are mainly the penalty when you are found guilty of taking kickbacks or fraudulent. The federal government department of health services decides on how much money you should be charged for violating each rule under the anti-kickback rules statue. For fraudulent claims, you are charged triple the amount of losses the government has incurred from your fraudulent activities.

  • Qui tam actions.

The false claims act allows a private party to report a case of health care fraud and abuse. In this case, there are several penalties that you can face. These are the qui tam actions. Legal fees, fines, settlement and recovery are the possible qui tam actions that may be taken.

  • Criminal sanctions.

This is the penalty given when you knowingly commit a health care fraud or abuse. Maybe you were previously found in a health fraud and all the legalities were explained and you still commit the crime. In this case, you are treated as a criminal and face criminal charges. You are jailed for several years or face other severe actions.


To effectively avoid health care fraud and abuse, both the consumers and providers should be involved in eliminating it and taking an ethical stand to avoid abuse in the health sector. Everyone should also understand the penalties and consult a health care fraud attorney whenever there is a problem.…

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