Medicare fraud penalties in Michigan include up to 10 years in federal prison per count, fines up to $250,000 per count, treble damages under the False Claims Act, per-claim civil penalties between $14,308 and $28,619, full restitution to the government, and mandatory exclusion from Medicare, Medicaid, and every other federal healthcare program. If a patient suffers serious bodily injury the prison ceiling rises to 20 years, and if a patient dies the sentence can reach life. The dollar figures and prison terms stack per count, and a single scheme usually generates dozens or hundreds of counts.
Federal Prison Time and Fines
The main federal healthcare fraud statute makes it a crime to knowingly carry out a scheme to defraud any healthcare benefit program, Medicare included. The sentence scales with patient harm:1Office of the Law Revision Counsel. 18 USC 1347 – Health Care Fraud
- Base offense: up to 10 years in prison per count.
- Serious bodily injury to a patient: up to 20 years per count.
- Patient death: a life sentence is possible.
The $250,000 fine ceiling for an individual felony conviction comes from the general federal sentencing statute.2Office of the Law Revision Counsel. 18 USC 3571 – Sentence of Fine Courts also order full restitution to repay the government for every dollar lost, and that number alone can dwarf the statutory fine. In a June 2025 case, a Bloomfield Hills physician received a four-year federal prison sentence for signing prescriptions that brace supply companies used to bill Medicare more than $6.3 million for equipment patients never ordered.3United States Department of Justice. Michigan Doctor Sentenced to Four Years for $6.3M Medicare Fraud Scheme
Attempt and conspiracy carry the same maximum penalties as the completed offense. A payment doesn’t have to clear for the full statutory exposure to attach.4Office of the Law Revision Counsel. 18 USC 1349 – Attempt and Conspiracy Criminal charges generally must be filed within five years of the offense.
Civil Liability Under the False Claims Act
The False Claims Act is the government’s main civil tool, and the financial exposure often outweighs the criminal fines. Anyone who knowingly submits a false claim for payment owes three times the government’s damages plus a per-claim penalty.5Office of the Law Revision Counsel. 31 USC 3729 – False Claims
The per-claim penalty is adjusted annually for inflation. For penalties assessed after July 3, 2025, each false claim runs between $14,308 and $28,619.6eCFR. Part 85 – Civil Monetary Penalties Inflation Adjustment A scheme that generated 500 false claims produces per-claim penalties alone above $7 million at the floor and above $14 million at the ceiling, on top of the trebled damages. That math is where the headline settlement figures in healthcare fraud cases come from.
The civil statute of limitations is longer than the criminal one. The government can sue up to six years after the violation, or up to three years after officials discover the material facts, with an absolute outer limit of 10 years from the violation.7Office of the Law Revision Counsel. 31 USC 3731 – False Claims Procedure
Kickback Charges
When the scheme involves paying for patient referrals, the Anti-Kickback Statute comes in alongside or instead of the general fraud charge. Both sides are exposed. Offering a kickback and accepting one are each punishable by up to 10 years in prison and a $100,000 fine.8Office of the Law Revision Counsel. 42 USC 1320a-7b – Criminal Penalties for Acts Involving Federal Health Care Programs A separate provision targets trafficking in Medicare beneficiary numbers, with fines reaching $500,000 for individuals and $1,000,000 for corporations.
Narrow exceptions exist for legitimate employee compensation, properly disclosed volume discounts, and payments through qualified group purchasing organizations. The exceptions are tightly defined, and Michigan prosecutors have shown little patience for arrangements that stretch them.
Exclusion From Medicare and Medicaid
Prison and fines end. Exclusion often doesn’t. A Medicare fraud conviction triggers mandatory exclusion from every federal healthcare program, meaning the provider cannot receive payment from Medicare, Medicaid, or any federally funded health program for any item or service they furnish, order, or prescribe.9U.S. Department of Health and Human Services Office of Inspector General. Exclusions Program
Exclusion reaches past the individual. Any hospital, clinic, or practice that employs an excluded person and bills a federal program for that person’s work faces civil monetary penalties up to $10,000 per item or service, treble the amount claimed, and possible exclusion of the employer itself.10U.S. Department of Health and Human Services Office of Inspector General. Special Advisory Bulletin on the Effect of Exclusions From Participation in Federal Health Care Programs Healthcare employers have an affirmative duty to check the OIG’s List of Excluded Individuals and Entities before hiring. Since most healthcare revenue flows through federal programs, exclusion typically ends a clinical career.
What Triggers These Penalties
Medicare fraud requires knowing, willful intent to deceive. That intent requirement is the line between fraud and the billing errors or sloppy recordkeeping that may count as abuse but don’t carry criminal penalties. The conduct that most often lands Michigan providers in federal court falls into a short list:
- Billing for services, tests, or equipment the patient never received.
- Upcoding, where a billing code describes a more expensive service than the one performed.
- Unbundling, where services that belong under a single code get split into separate charges.
- Paying or receiving kickbacks for Medicare-covered referrals.
- Falsifying medical records to justify the claims submitted.
Falsifying records carries separate exposure under state law. A Michigan healthcare provider who intentionally places misleading or inaccurate information in a patient’s medical record commits a felony, and destroying records to conceal responsibility for a patient’s injury or death is a separate felony charge.11Michigan Legislature. MCL 750-492a
Who Prosecutes Medicare Fraud in Michigan
Michigan is one of a handful of states where federal enforcement is concentrated. The Health Care Fraud Strike Force, a joint DOJ and HHS-OIG operation, keeps a permanent team in Detroit, one of about a dozen cities nationwide with a dedicated Strike Force presence.12U.S. Department of Health and Human Services Office of Inspector General. Medicare Fraud Strike Force Strike Force teams run data analytics on billing patterns and coordinate with the FBI and local law enforcement to build cases.13Federal Bureau of Investigation. Health Care Fraud Charges are brought through the U.S. Attorney’s Offices for the Eastern and Western Districts of Michigan.
At the state level, the Michigan Attorney General’s Health Care Fraud Division operates as the federally certified Medicaid Fraud Control Unit, with its own attorneys, auditors, and investigators handling false billings, kickback schemes, unlicensed practice, and unlawful controlled-substance distribution.14Michigan Department of Attorney General. Health Care Fraud Division Because many beneficiaries are dually eligible for Medicare and Medicaid, state and federal investigators regularly work the same cases together.
Reducing Exposure: Self-Disclosure and Whistleblower Routes
Providers who find a billing problem inside their own organization have a formal way to get in front of it. The OIG’s Provider Self-Disclosure Protocol lets healthcare providers and suppliers voluntarily report self-discovered conduct that could violate civil monetary penalty rules.15U.S. Department of Health and Human Services Office of Inspector General. Health Care Fraud Self-Disclosure Self-disclosure doesn’t guarantee a particular outcome, but OIG has historically resolved these matters with lower damage multipliers and reduced penalties than cases the government opens on its own. The submission must meet the protocol’s requirements or it may be rejected, and providers already operating under an Integrity Agreement with OIG have to contact their monitor first.
Employees, contractors, and others with firsthand knowledge of false claims have their own path through the qui tam provisions of the False Claims Act. The relator files a complaint under seal in federal court and provides a copy with all material evidence to the U.S. Attorney General and the local U.S. Attorney. The government then has at least 60 days to investigate and decide whether to intervene, though extensions are common in complex fraud matters.
If the government intervenes, the whistleblower receives between 15 and 25 percent of what’s recovered. If the government declines and the whistleblower proceeds alone, that share rises to between 25 and 30 percent. Reasonable attorneys’ fees and costs come from the defendant in either case.16Office of the Law Revision Counsel. 31 USC 3730 – Civil Actions for False Claims A whistleblower who planned or initiated the fraud can see their reward reduced, and a whistleblower convicted of criminal conduct tied to the scheme is dismissed from the civil case and recovers nothing.
Federal law also protects whistleblowers against retaliation. An employer who fires, demotes, suspends, or harasses an employee for reporting fraud or participating in a qui tam action owes reinstatement, double back pay with interest, and compensation for special damages including litigation costs. The employee has three years from the date of the retaliation to file.