Discussions about health care fraud often highlight the wrong concerns. Many people associate health care fraud with one of two situations. They imagine people trying to secure care or coverage for which they are not qualified or engaging in identity theft to access medical insurance or treatment.
While both of those forms of fraud can be problematic, they are far from the most common or costly health care fraud issues. When looking at the losses sustained by care providers, insurance companies and the government, health care providers are the biggest source of health care fraud.
Health care fraud often relates to billing issues
A broad assortment of different billing practices could lead to allegations of health care fraud. Both health care providers and the secondary professionals providing support services could face accusations of fraud.
Coding specialists could face accusations of fraud for upcoding or attempting to bill for a more expensive service than the one provided. Billers could face fraud allegations for unbundling discounted services or billing for canceled appointments. Physicians and other care providers could face fraud allegations if they intentionally misrepresent the care that they provide to bill for more than they should.
Allegations of health care fraud can lead to federal charges, especially if the scenario involves government insurance programs. Depending on the impact of the alleged fraud, people working in the health care sector could face prison time, fines and even orders of restitution. They may also face professional censure for their conduct.
Those accused of healthcare fraud and other forms of white-collar crime may need help protecting themselves. Reviewing business practices and the pending charges with a skilled legal team can help those accused of healthcare fraud develop a defense strategy to prevent a career-ending conviction.
