What does health care fraud look like, and who can be charged?

On Behalf of | Oct 5, 2021 | Health Insurance & Medicare Fraud |

According to the FBI, health care fraud costs American taxpayers tens of billions of dollars every year. It can lead to higher taxes, higher costs for health care and insurance, and even expose people to unnecessary medical treatments. Because the costs are so high and the effects so far-reaching, state and federal law enforcement take health care fraud allegations very seriously.

For instance, the Department of Justice recently announced it had arrested 138 people in what it said were a variety of health care fraud schemes in 31 federal districts across the country. Among the arrested were 42 licensed medical professionals, including doctors and nurses. According to the Justice Department, the defendants’ actions cost the United States more than $1.4 billion.

Wide variety of allegations

Although the arrests were announced at the same time, the alleged crimes represent a wide variety of behavior in different settings.

Most of the cases involved alleged telemedicine fraud schemes. For instance, a number of the defendants were charged with ordering unneeded expensive medical equipment for medical facilities in exchange for kickbacks. The telemedicine cases also involved instances in which medical providers allegedly billed Medicare for consultations with patients that did not actually occur as claimed.

Other cases involved medical professionals who allegedly referred patients to fraudulent drug and alcohol dependency treatment programs in exchange for kickbacks. According to the Justice Department, some of these programs subjected patients to unnecessary medical procedures and they charged the government thousands of dollars for simple drug tests.

Many other cases involved allegedly fraudulent prescriptions for opioid pain relievers in exchange for cash or other kickbacks.

A variety of defendants

As you can see from this recent Justice Department announcement, the term “health care fraud” covers a wide range of crimes, and the people who end up facing health care fraud charges can come from different walks of life. Many of them are doctors, nurses or other licensed medical professionals, but they can also include equipment providers and suppliers who allegedly overcharge for their goods and services.

The defendants in health care fraud cases often include business entities – both nonprofit and for-profit companies – but just as often they include individuals.

Prosecutions often allege sophisticated schemes in which defendants went to great lengths to deceive others in order to make money. Typically, the more elaborate cases are the ones that make the news.

Behind these charges there is often a relatively straightforward and rather sad story involving someone who suffered from addiction, who got in over their head, or who simply made a mistake. And sometimes the allegations are completely wrong altogether.

Whatever the back story of the situation, defendants in these cases face a great deal of trouble. The charges are serious, with life-changing consequences that can wreck careers and personal lives. It is absolutely crucial that they seek out help from criminal defense attorneys who have experience in health care fraud defense.