What different forms does health care fraud take?

On Behalf of | Jun 1, 2019 | Health Insurance & Medicare Fraud |

If you find yourself accused of health care fraud, you might feel unsure about what that actually means. Health care fraud is an incredibly broad form of crime that can involve many different kinds of fraud.

Some people mistakenly believe that health care fraud only applies to people illegally obtaining benefits they shouldn’t receive. However, individuals seeking personal health care benefits are only a tiny fraction of the health care fraud that happens in the United States.

Understanding the different forms that health care fraud can take can help you determine if the charges you face are reasonable and how you can potentially defend against them.

Health care fraud can include getting benefits you don’t deserve

The most common mental image of health care fraud people have involves someone intentionally gaming the system to get benefits they don’t really need or deserve. For example, Medicaid provides medical coverage for those who have low income and cannot afford private health insurance policies.

An individual could intentionally misrepresent their income as a means of qualifying for Medicaid benefits. However, lying on an insurance application is only one of many kinds of health care benefit fraud.

Some people will steal the identity of someone else or use their policy information in order to use their health insurance. Individuals who engage in that practice could find themselves facing both fraud and identity theft charges. Others could pretend to have a condition in order to later sell the medication or medical supplies they receive to others for a profit.

Health care professionals are responsible for a lot of medical insurance fraud

Contrary to the popular belief that most insurance fraud involves individuals, the most expensive kinds of insurance fraud typically involve medical care providers. Sometimes, it’s one doctor or dentist. Other times, it could be an entire practice involved in the fraud. Anyone from the doctor who performs procedures to the medical billing professional who enters the billing codes could face fraud charges.

Common forms of medical billing fraud include billing for services someone didn’t receive, billing for a more expensive procedure than they did receive, intentionally ordering unnecessary procedures for billing purposes or unbundling services. Unbundling means billing individually for procedures typically combined with a single reduced rate. Companies do this to maximize the compensation the practice receives.

Different forms of fraud require different approaches

The kind of insurance fraud involved in the allegations against you will absolutely impact your defense strategy. For example, if you face allegations related to fraud and conspiracy as a billing specialist, you may be able to negotiate a plea bargain if you testify against the people who planned the fraud. If you received benefits that you should not have, you may be able to arrange a defense based on your lack of knowledge or intent to commit fraud.

Figuring out the best way to defend yourself against a white collar crime isn’t easy. Your first step should be to sit down with an experienced attorney who can talk to you about the charges, the penalties and the defense options available to you.