Some kinds of criminal charges are classified as federal offenses. Health care fraud related to insurance billing is typically a federal crime. Such offenses make use of federal financial infrastructure and may involve government insurance programs like Medicare or Medicaid. Therefore, the charges often involve federal prosecution even if the physician only practiced medicine in one state.
Healthcare professionals accused of involvement in fraudulent billing schemes face numerous consequences. A federal conviction for health care fraud could lead to incarceration. The accused professional could lose their license to practice medicine. They could also be at risk of life-altering financial penalties. Health care fraud, in particular, may create life-altering economic challenges for those who plead guilty or get convicted after fighting their charges in federal court.
There are two types of financial penalties possible
Sentencing guidelines for both state and federal offenses tend to include a variety of different penalties that the courts can impose. In addition to incarceration, probation and community service, fines imposed as a financial penalty are relatively common in criminal cases.
Depending on the number of charges an individual faces, the fines imposed could add up to six figures or even more in some cases. The fines are in addition to cover the costs of the trial. The convicted professional might have to spend years paying off those fines and court costs.
As if that weren’t enough of an economic setback, health care fraud charges typically also come with orders of restitution. For example, a case recently resolved involving a New York physician prosecuted in federal court saw a judge order the defendant to pay more than $336 million in restitution based on fraudulent billing practices.
Orders of restitution can add up to as much as the total amount improperly billed in some cases. The need to pay restitution is in addition to the cost of legal representation, court costs and any fines imposed as part of a criminal sentence.
Healthcare professionals facing allegations of health care fraud need to understand the risks so that they don’t make the wrong choice when entering a plea. Fighting charges may give a professional an opportunity to rebuild their finances and professional reputation, whereas a guilty plea might lead to an insurmountable financial obligation for a defendant.
