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Health Care Fraud Remains High Priority for Federal Government as Monetary Penalties Increase

In a recent bipartisan budget bill, civil monetary penalties for health care fraud were substantially increased.  Last month The Bipartisan Budget Act of 2018 was enacted with the primary purpose of continuing to fund the federal government and extend the Children’s Health Insurance Program (CHIP).  However, the legislation also had major effects on the healthcare industry, as it more than doubles the civil monetary penalty amounts and dramatically increases the Anti-Kickback criminal felony fine and term of imprisonment.  The main changes are as follows:

  • The civil monetary penalty for violating the Anti-Kickback Statute increases from $50,000 to $100,000 per violation;
  • The civil monetary penalty for conduct that previously was punishable by up to $10,000 per violation (for example,  knowingly filing an improper claim) is now punishable by up to $20,000 per violation;
  • The maximum criminal penalty under the Anti-Kickback Statute increases from $25,000 to $100,000 per violation; and
  • The maximum term of imprisonment under the Anti-Kickback Statute increases from five (5) years to ten (10) years.

These provisions underscore the federal government’s continued commitment to combat health care fraud and abuse.  As fraud and abuse remains a top priority for federal agencies, health care providers can expect to see a more aggressive approach in dealing with such misconduct.  

© 2019 Dinsmore & Shohl LLP. All rights reserved.


About this Author

D Michael Crites, white collar criminal defense lawyer, Dinsmore Shohl, law firm

D. Michael Crites’ practice focuses exclusively on white collar criminal defense and complex business litigation. As the former United States Attorney for the Southern District of Ohio and an Assistant United States Attorney for the Southern District of Ohio, he has years of grand jury and litigation experience in federal court and regularly litigates and negotiates global settlements of criminal, civil and regulatory matters on behalf of corporations and businesses throughout the United States. He also serves as Special Counsel to the Ohio Attorney General.

Daniel S. Zinsmaster, Dinsmore Law Firm, Health Care Lawyer

Dan provides trusted counsel and advocacy to health care clients on a variety of matters, such as corporate compliance, provider credentialing, administrative proceedings and litigation.  He also advises clients on practice formation and acquisition, as well as contract review and preparation.  In recent years, Dan has helped health care companies and providers navigate through fraud and abuse investigations, antitrust reviews, and other white collar criminal matters.  He is a frequent author and lecturer on telehealth and telemedicine issues.

Prior to joining Dinsmore, Dan practiced for nearly seven years with the State Medical Board of Ohio, where he advised board members and agency personnel on issues related to the Medical Practices Act of Ohio, Chapter 119 Administrative Procedures, and federal rules and regulations implicating the area of health care.  His substantial regulatory experience enables him to bring a unique and insightful perspective to handling diverse and complex health care matters, and his thorough understanding of health care laws and policies helps him serve as a valuable resource to corporations, health care associations, hospitals, medical practices and individual practitioners. 

In addition to his experience with federal and state health care regulatory agencies, Dan has successfully aided clients appearing before a number of other administrative or executive entities, including the Ohio Department of Commerce, Accountancy Board of Ohio, and the Ohio Board of Registration for Professional Engineers and Surveyors.  He previously served as an extern for the Legal Office of the Ohio governor, as well as the Business & Regulations Division of the Columbus city attorney’s office.

(614) 628-6949
Sydney Pahren, Dinsmore Law Firm, Columbus, Corporate Law Attorney

Sydney is a member of Dinsmore’s Corporate Department, where she focuses her practice on health care law. 

She has experience researching legal issues in health care, litigation, labor & employment and corporate law. She is a graduate of The Ohio State University Moritz College of Law where she was an articles editor on the Ohio State Law Journal and an executive board member of the Black Law Students Association.