Medicare fraud is illegal and involves intentionally abusing the Medicare system for your own personal gain (Fraud and Abuse, 2007). Medicare billing fraud means that a doctor intentionally bills Medicare for services that weren’t needed, so that they can get reimbursements (Fraud and Abuse, 2007). An example of Medicare fraud could be, if you ask your doctor for a prescription that’s not actually for yourself. Medicare abuse can happen when a practice doesn’t follow good medical practices or doesn’t follow appropriate billing procedures (Fraud and Abuse, 2007). For example, a physician may run tests on a patient that aren’t actually necessary. Medicare abuse is a serious offense and is illegal just like fraud. Some Medicare fraud and abuse are punishable by imprisonment or exclusion from Medicare altogether (Harris, 2014). …show more content…
“Healthcare organizations are subject to the FCA because Medicare and Medicaid are government programs involving claims and payments (Harris, 2014).” An example of violating the FCA could be, a physician knowingly submitted a claim to Medicare for a higher-level service than they actually provided. So, if any person submits a claim to the government that they know is false, is liable. Providers that receive Medicare overpayments have to give the money back within 60 days (Harris, 2014). The civil penalty under the FCA is a fine of $5,000-$10,000 for each false claim, plus three times the amount of damage the government suffered (Harris, 2014). This can lead to a huge amount of money, such as millions of