At the state and federal level, fraud related to health care and Medicare cost taxpayers billions of dollars a year and can increase risk to patients who are exposed to unneeded medical procedures.

If you’re charged with Medicare or health care fraud, you may face serious penalties imposed by state or federal courts. Attorney Michael J. Petro has extensive experience providing criminal defense for individuals charged with crimes related to health care fraud.

What Constitutes Health Care Fraud?

The FBI takes a lead role in investigating fraud related to federal and private health insurance programs. Investigations into health care fraud are conducted out of the agency’s 56 field offices, which use strike teams, task forces and undercover operations to gather evidence.

The agency also works cooperatively with other federal agencies, including the Food and Drug Administration and the Drug Enforcement Administration, and it teams with state and local agencies as appropriate.

Health care fraud often relates to obtaining patient insurance information and using it in an illegal manner. Such fraud can take place through a variety of methods, including providing a gift or cash to insurance beneficiaries to go to a medical clinic or other location where personal data can be gathered.

In some cases, insurance information is obtained when patients receive a free health screening at a health fair.

Medical personnel are implicated in some health care fraud cases; for instance, they may provide patient insurance information to individuals perpetrating fraud schemes. Patients’ personal and billing information also may be purchased from marketers and companies for the purpose of fraudulent billing.

Health care fraud often is discovered because patients notice incorrect information on billing statements or other documentation and contact their medical providers or insurance companies.

States Looking for Revenue Through Uncovering Fraud

States are looking for ways to bring in additional revenue and contain the rapidly expanding costs of their Medicaid programs, and they are going to great lengths to uncover potential Medicaid fraud and abuse.

In most cases, Medicare fraud involves providing or using false information to obtain unauthorized benefits, and it can include any actions that are not consistent with standard business and medical practices and that cause costs to unnecessarily increase.

A number of programs at the state and federal level exist solely to root out and prosecute cases of Medicare abuse by patients, providers and insurers.

Medicare Fraud Cases in Illinois

The Illinois State Police note that Medicare fraud can take a variety of forms, but it typically involves defrauding the Medicare system through billing for services that were not provided or that were not provided as described. Medicare fraud also can come into play in cases of neglect or abuse, such as failure to provide needed medications or medical services.

In recent years, a number of people were prosecuted in Illinois on charges related to defrauding a Medicare program that covers the costs of personal assistants who help sick or disabled Medicare patients remain in their own homes. The program is intended to help control costs for the state by keeping patients out of expensive nursing homes and hospitals. However, state officials found that some of the Medicare beneficiaries were in hospitals while their personal assistants continued to be paid for providing services in the patients’ homes.

In one case, a personal assistant continued billing for services six months after the Medicare patient died, and other assistants who were incarcerated on other matters continued billing for home care that was not provided.

Medicare beneficiaries also are sometimes involved in fraud schemes, officials say, in some cases splitting Medicaid funds with another party for care that was not provided.

Have You Been Charged With Medicare or Health Care Fraud in Illinois?

Federal and state authorities are aggressive about prosecuting cases of perceived fraud relating to health care or Medicare, and innocent people can be caught up in investigations. If you’re charged and convicted of health care fraud, you can be subject to serious penalties such as lengthy prison sentences, fines, and restitution.

If you’ve been charged or believe that you’re being investigated for Medicaid or health care fraud, it’s vital that you work with an experienced criminal defense attorney. For immediate assistance, contact Attorney Michael J. Petro at 888-457-2676.