Prosecuting Medicare Fraudsters: Lessons Learned from Recent Litigation

Abstract

The researchers investigated the 41 appellate cases of Medicare fraud that were decided by the 11 circuits of the United States Court of Appeals during the past three years (January 2014 through December 2016). A study of those cases led to these conclusions: (1) the crimes for which Medicare fraudsters are most often prosecuted are healthcare fraud, conspiracy to commit healthcare fraud, payment of kickbacks, and identity theft; (2) Medicare fraudsters were personnel in all aspects of healthcare; (3) types of Medicare fraud included overbilling for services and billing for services to fake patients; and (4) Medicare fraud convicts received variable prison sentences.