Health insurance and Medicare fraud is a federal offense. That said, a conviction can lead to severe consequences for you and your practice, including fines, imprisonment and license revocation, among others.
Losing a medical license is perhaps the biggest fear among providers accused of this crime, seeing that it can also mean loss of future livelihood. However, an allegation is far from a conviction, and there are many ways to protect yourself.
What happens when you face insurance fraud allegations?
Health insurance fraud can take many forms, including but not limited to:
- Performing unnecessary treatments
- Billing for services not provided
- Charging insurance providers for more expensive procedures
- Submitting false records to increase reimbursement
Some healthcare providers intentionally commit these criminal acts. However, in many cases, fraud allegations stem from human error. Nevertheless, it is important to treat any accusation seriously.
If an insurance company believes you are committing fraud, they may report you to the Tennessee Department of Health or another government agency handling these cases.
The investigating body may ask you to provide documentation or explanations about the alleged fraud. This is an opportunity to explain your mistake.
However, it is crucial to have a defense lawyer by your side to ensure you do not accidentally incriminate yourself. They can also provide guidance during the entire investigation process, from the initial notification of the allegation to any formal proceedings.
How can an insurance fraud case affect my license?
While undergoing investigation for fraud, the Department of Health, the Tennessee Board of Medical Examiners or another authority may suspend your license temporarily.
If the investigation reveals intentional fraud or other untoward behavior, the Board may impose disciplinary actions. These can include fines, suspension or, in severe cases, permanent withdrawal of your license.
An allegation in and of itself can have far-reaching impacts on your practice. Even if the alleged fraud is simply a clerical mistake, you must be prepared to defend yourself.