Health care fraud is a category of crime involving false claims made for insurance or health benefits. The U.S. government has estimated that health care fraud costs taxpayers up to $100 billion a year. The government seeks to prevent and penalize this type of fraud through a statute known as the False Claims Act.
Some of the most common types of health care fraud that may fall under the False Claims Act involve a health care provider allegedly filing a fraudulent claim for services. This could happen to any medical professional at their place of business if someone in the office makes errors and then bills a health insurer like Medicare or Medicaid. Healthcare providers are required to follow a strict protocol when it comes to medical records and medical billing. A failure to adhere could result in being charged with healthcare fraud. Acts of health care fraud are numerous and could include overbilling, waiving co-pays, forging signatures or even tampering with medical records.
If you have been accused of health care fraud, you may not even know what you have done wrong. That’s because the specific fraud allegation could entail any number of things. The False Claims Act offers an incentive for individuals to sue a provider for health care fraud, so it’s possible that the charges could have come to light due to a prior patient treated at a medical office, and not the government themselves. The U.S. Department of Justice takes health care fraud seriously and has a specific unit addressed to investigating these allegations.
Defending yourself and your practice against a health care fraud allegation is serious. The weight of this matter could seep into every inch of a person’s practice. Putting up a solid defense strategy is the best option for a person facing health care fraud charges. Understanding what you are being charged with is crucial to defending oneself properly.
Source: employment.findlaw.com, “False Claims Act and Healthcare Fraud,” Accessed June 5, 2017