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How is health care fraud committed and what are the penalties?

On Behalf of | Oct 8, 2021 | Criminal Defense |

Health care fraud is a huge problem in California and other states. It’s a crime that can be complex depending on the factors of the case. Whether health care fraud is committed by a medical professional or a person using health insurance, it can cost a lot of money. You should know how this crime is committed and the penalties a conviction carries.

How is health care fraud committed?

Health care fraud is a serious crime that needs a good criminal defense strategy. Most offenses are committed by health care providers, but some may also be committed by individuals who falsely pass themselves off to be doctors. It’s a crime that gives honest doctors a bad reputation. The offense is commonly committed in the following ways:

  • Billing for medical services that were never provided
  • Billing for pricier services that were never provided
  • Performing medical services that were unnecessary to gain higher insurance payments
  • Deliberately misrepresenting treatments not covered as necessary to gain insurance payments
  • Falsifying medical records, procedures and diagnoses
  • Unbundling or billing for different steps of procedures to make them appear to be separate procedures
  • Billing multiple copayments to a patient for fraudulent purposes
  • Accepting kickbacks for referrals
  • Waiving copayments or deductibles for care and billing the insurance carrier higher

How health care fraud hurts parties

A strong criminal defense strategy is needed in health care fraud cases. This type of crime can hurt multiple parties, including other health care providers, patients and insurance companies.

Sometimes, health care fraud is committed through medical identity theft. This offense occurs when a person fraudulently gains another’s name and other personally-identifying information to obtain medical insurance and medical services. As a victim of this crime, a person can receive inappropriate medical treatment and suffer the problem of being uninsurable. Even though they are a victim and not the perpetrator, health care fraud can cause serious damage to the individual in the long term.

Penalties for health care fraud

Health care fraud is a federal offense, meaning that the penalties for a conviction can be harsh. A person can serve up to 10 years in federal prison. However, depending on the severity of injury to patients, the sentence can be elevated to 20 years. If a person died as a result of the fraud, the individual could serve life in prison. Fines are also imposed for a conviction.