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What constitutes health care fraud?

On Behalf of | Aug 2, 2019 | White Collar Criminal Defense

Statistics seem to be lacking when it comes to how many medical providers and their support staff are charged with health care fraud each year. It’s safe to say that only a fraction of them intentionally engage in such impropriety though. If you’re unsure as to what constitutes health care fraud, many different actions fall under the umbrella of this crime.

Medical providers can be charged with health care fraud if they purposely misdiagnose a patient, especially if they end up ordering tests, procedures or performing a surgery that’s not medically necessary.

Health care workers who bill their clients or patients for services that they didn’t receive can also be charged with fraud. If they unbundle procedures that are typically performed and billed in conjunction with each other, then this too could land them in hot water.

It’s the responsibility of medical providers and their support staff to only collect the deductibles and co-pays described in their managed care contract. If they fail to do so or request for a patient to pay more than that, then they can be charged with health care fraud.

If they bill for a procedure that’s more costly than what was actually performed or tell a patient that it’s not covered when it really is, then they may face charges as well.

Any medical provider, billing company or support staff accepts gifts or monetary kickbacks for referring patients may also be charged with this crime.

Consumers can also be charged with health care fraud. If they submit an altered receipt to their insurance company for reimbursement, then they may face fraud charges. This is especially the case if they didn’t receive the medication or services listed on it. If they attempt to be seen by a medical provider using someone else’s insurance, then they can be charged with this crime as well.

Federal prosecutors, or U.S. Attorneys, tend to be aggressive in going after individuals who are accused of white-collar crimes such as health care fraud. You can face significant time in federal prison if you’re convicted of such an offense.

If you’re charged with such a crime, then you should align yourself with a white-collar criminal defense attorney in Fayette. When the states are as high as they are, you’ll want someone representing you who is prepared to advocate for you in a federal courtroom here in Kentucky.