Civil Health Care Fraud

i-medicalinsurancefraudEven where the health care provider is not prosecuted criminally, these investigations can lead to sever monetary penalties under the False Claims Act, the Civil Monetary Penalty Law and the “Stark Law.” More importantly, violations can lead to a health care provider’s exclusion from participating in, and/or receiving payment from, a Federal health care program including Medicare and Medicaid.

Given the importance of Medicare and Medicaid in a small practitioner or provider’s livelihood, exclusion from participation in these programs can constitute a “financial death sentence.” The three primary civil health care fraud statutes are the: