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Healthcare Fraud

Healthcare fraud is a term used to describe the white collar crime of filing a claim with the healthcare industry in order to deprive them of funds. A number of activities fall under the broad category of healthcare fraud, many of which healthcare providers and members are not even aware qualify as fraudulent, which makes it especially important for those who have been charged with healthcare fraud to contact an experienced white collar crime attorney who may be able to get your charges reduced or even dismissed.

The Elements of Healthcare Fraud

A person can be charged with committing healthcare fraud if he or she:

  • Defrauds any healthcare benefit program; or
  • Obtains, by false pretenses or promises, funds belonging to a healthcare benefit program.

According to federal law, a person does not need to have actual knowledge that their actions constitute fraud or have the intent to commit a violation in order to be convicted. This requirement can have serious consequences for anyone accused of healthcare fraud, as those who are convicted of this offense face hefty fines and up to ten years in prison. If a court determines that a violation resulted in a serious bodily injury, the defendant’s prison sentence could even be increased to 20 years.

Fraudulent Activity

Healthcare fraud charges often involve allegations of the following activities:

  • Obtaining subsidized prescription medications and reselling them for a profit;
  • Billing for medical services or goods that were never provided;
  • Billing twice for the same service;
  • Requesting reimbursement for non-covered services from Medicare or Medicaid;
  • Accepting or giving kickbacks for referrals;
  • Prescribing unnecessary treatment; and
  • Hiring unqualified staff.

However, healthcare providers are not the only individuals who can be charged with fraud. Claims can also be filed against individuals who:

  • Provide false information in applications for healthcare programs or services;
  • Use benefits for non-medical related purposes; and
  • Use someone else’s insurance card.

These activities are investigated primarily by the Federal Bureau of Investigation (FBI).

Medicare Fraud

One of the most commonly charged types of healthcare fraud is Medicare fraud, which involves:

  • Knowingly submitting false claims to obtain healthcare payments or benefits for which the person is not entitled; and
  • Intentionally offering payment to induce referrals for services that are reimbursed by the federal government.

Activities that fall under the purview of Medicare fraud include:

  • Billing for appointments that patients did not keep;
  • Billing for more expensive services than were actually performed; and
  • Falsifying medical records.

Those who are convicted of Medicare fraud also face fines and jail time. However, healthcare providers are also at risk of being banned from participation in federal programs and may even lose their professional licenses.

Contact an Experienced White Collar Crime Attorney Today

Please contact the law firm of Jeffrey S. Weiner, P.A., Criminal Defense Attorneys by calling (305) 670-9919 to schedule an initial consultation with a dedicated white collar crime attorney who can evaluate your case. We are eager to help you immediately.


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