Understanding fraud in the health insurance arena

On Behalf of | Apr 7, 2021 | Health Insurance & Medicare Fraud |

Access to medical care is a critical component of maintaining one’s health. When a Tennessee resident has a medical problem, they may contact their doctor and schedule an appointment to have their ailment assessed, diagnosed, and treated. Once the patient’s care is underway, they may begin to receive bills for their medical care.

When a person has health insurance, their insurance provider may cover some or all their medical costs. In some cases, medical offices may make errors in the billing of the services they provided and may inadvertently double bill or provide inaccurate information on patients’ expense statements. When this happens, medical care providers may be accused of committing fraud and attempting to receive more money than they are owed for the services they provided.

Health insurance fraud is a damaging criminal offense that is often erroneously alleged against honest medical offices and providers. This post will discuss fraud in the context of health care and will examine its elements. Readers are reminded that no part of this post offers medical advice and all questions about fraud should be directed to trusted criminal defense lawyers.

The elements of fraud

Fraud is a crime that can be alleged in many different contexts. Generally, though, fraud involves two specific elements: an intent and an action. This means that a person must intend to commit fraud to be guilty of the crime; accidents or mistakes that result in losses should not be considered acts of fraud because the alleged perpetrators did not mean to cause their victims to lose money.

Additionally, individuals who are accused of fraud must be shown to have taken action to ensure that their fraudulent intentions were carried out. In the context of insurance fraud, this may translate to a medical provider intentionally altering the cost of services provided to receive more money than it should be due from a patient or their insurance company.

Defending accusations of health insurance fraud

As stated, fraud is a crime that requires different elements of proof to secure convictions. When a medical provider is accused of health insurance fraud, they may have options to defend themselves and overcome their accusations. Demonstrations of legitimate mistake, showings of unintentional error, and other offerings of proof may help them show that no intent existed when accidental problems arose in the billing of medical-related services.

Fraud is a serious crime. Those facing fraud charges should not attempt to deal with them alone. Criminal defense lawyers can offer support and advocacy to protect defendants’ rights.