Medical professionals can be frequently accused of engaging in Medicare or Medicaid billing fraud. This could be due to them being accused of making excessive, false or unauthorized charges. However, these reimbursement requests are often made out of genuine error or because of an honest mistake.
If you have been accused of billing fraud as a medical professional, it is important that you aggressively defend yourself. Being charged with health care fraud could have serious legal consequences, and your reputation as a medical professional could be at stake. Understanding the elements of the crime of fraud could help you to form your defense.
You must have knowingly made a false or misleading statement
Fraud cannot arise out of an honest mistake. In order to be guilty of fraudulent activity, you must have made an intentionally false or misleading statement. Therefore, by arguing that the billing error you made was an unintentional mistake, you could avoid charges.
You must have made this statement in connection with a claim for payment
Even if you made a false statement, it does not count as the crime or fraud unless the statement was made in connection with a claim for monetary payment.
The statement is material
The false statement made should be linked with the outcome of the claim for insurance. If a false statement did not affect a patient’s ability to make a health insurance claim, it should not be counted as a fraud.
You should not waste time if you have been accused of billing fraud in connection with health care insurance. Make sure that you take swift action so that you can build a strong defense.