The Challenges of Health Care Fraud

The Challenges of Health Care Fraud

In 2018 alone, more than $3.6 billion was spent on health care throughout the United States. This number represents billions of health insurance claims for services. Although we would like to believe that the services being billed are valid and provided great relief for patients, a substantial amount of claims are actually made with fraudulent intentions. Not only do acts of fraud impact insurance companies and government agencies, but it impacts innocent patients as well.

What Does Health Care Fraud Look Like?

The majority of health care fraud acts are committed by a very small number of actors. Although some acts are performed by dishonest health care providers, there are many instances where health care fraud acts are performed by people pretending to be health care providers. These deceitful actions only sully the reputation of our medical providers. Some common types of health care fraud include:

  • Billing Medicare, Medicaid, and Tricare for services that were never rendered.
  • Billing insurance companies and government programs for services at inflated costs.
  • Performing services and providing care that is not medically necessary just to generate payments.
  • Falsifying diagnosis of patients’ conditions to justify the provision of treatment.
  • Misrepresenting non-covered treatments by saying they are medically necessary when they are not.
  • Accepting kickbacks for services and referrals.
  • Billing patients over the required copayments for services that were paid in full by their healthcare plan.
  • Waiving the copayments to patients and overbilling their insurance companies.

Victims of False Records

When doctors falsify records of patients to obtain payment for medically unnecessary services and treatments, they are misrepresenting the truth. In some cases, patients are exploited because providers fill their medical records with false diagnoses and medical conditions. In some cases, they exaggerate the severity of health conditions they do have. This can jeopardize their ability to get the appropriate treatment they have for their illnesses and leave them vulnerable to adverse health consequences.

A Qualified Health Care Fraud Defense Attorney Can Help You 

Being convicted of healthcare fraud can have a detrimental impact on your life. Those convicted of health care fraud can face up to five years in prison for each offense. Federal health care fraud can result in a sentence of at least 10 years in prison for each offense. Either crime can result in tens of thousands of dollars in fines, loss of licenses to practices, and various other negative consequences. If you are being accused of committing health care fraud, it is imperative that you proceed with caution. You will want to work with a team of proven legal representatives who can guide you and fight to protect your legal rights.

Our defense attorneys at Healthcare Fraud Group work diligently to protect the legal rights of the accused nationwide. We fight to help those accused of health care fraud and other serious crimes obtain the best possible outcomes for their cases. If you were accused of health care fraud, contact our law firm at (888) 402-4054 to see how our knowledgeable health care fraud defense attorneys can help you.

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