What to know about healthcare fraud accusations

On Behalf of | May 24, 2023 | Federal Crimes

Healthcare fraud can carry serious criminal consequences. While trillions of dollars are paid for much-needed treatments and surgeries, billions  are lost to  criminal activity based on data from the National Health Care Anti-Fraud Association (NHCAA),

Depending on the agency reporting, financial losses caused by health care fraud account for three to ten percent of healthcare expenses, totaling in excess of $300 billion. The financial stakes have motivated law enforcement to ramp up prosecutorial pursuits over alleged unnecessary medical procedures. Consumers pay higher insurance premiums and increased taxes due to healthcare fraud.

Wide-ranging criminal offenses

Criminal charges of healthcare fraud stem from intentionally deceiving the system to secure illegal benefits or payments.Criminal acts can also take the form of forgery, diversion and doctor shopping. Investigations are often conducted by the Federal Bureau of Investigation.  The FBI also partners with local and other national agencies.

Specific examples of these crimes include:

  • Double billing that includes multiple claims for one service
  • Phantom billing involving a service or supplies that patients did not receive
  • Unbundling by submitting more than one bill for the same service
  • Upcoding through billing for more money than the service patients received

An arrest for healthcare fraud requires immediate legal representation. The consequences of conviction are severe and can permanently damage both freedom and reputation. A skilled attorney with experience  in this complex area of criminal law can help improve the odds against prosecutors with virtually unlimited resources.

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