What are the potential penalties for Medicare fraud?

Pharmacists and other individuals who commit Medicare and Medicaid fraud face serious federal charges. The Federal Sentencing Guidelines mandate jail time, disbarment, fines and even deportation for fraud-related convictions.

Before facing Medicare fraud charges in court, learn more about the potential penalties for these offenses.

Base sentencing level

First, the judge will determine the base sentencing level for the fraud offense in question. Generally, fraud receives a score of six, or seven if someone suffered a serious injury as a result of the fraudulent actions. Offense levels range from one for minor federal criminal to 43 for the most serious crimes.

Contributing factors

The base offense level will receive adjustment based on other factors such as criminal history and the monetary amount of the fraud. For example, the offender will receive two points if he or she was already on parole at the time of the fraud. If the fraud totaled more than $30,000 in losses, the judge would add six points.

Federal Sentencing Guidelines table

Next, the judge will compare the total offense score to the sentencing guidelines table. Using the example above, a person with a base fraud score of six, some criminal history and six loss points would have a score of 12 and receive a Level II criminal history categorization. Based on the guidelines, this individual could receive a sentence of 18 to 24 months in prison. In contrast, a person in the same situation but with no criminal history could receive a sentence of 10 to 16 months in prison.

Although Federal Sentencing Guidelines help determine the person’s prison sentence for Medicare and Medicaid fraud, the judge can adjust the final sentence at his or her discretion. For example, he or she will consider the offender’s character, the number of affected victims, the total cost of the fraud, the person’s character, criminal history and other factors that support the need for a shorter or longer sentence.