The health care industry is one of the most complex and deeply layered institutions in the country. Governed by countless laws and driven by endless paperwork, both patients and health care professionals often find themselves confounded by the rules and regulations. It is easy to make mistakes, and authorities are zealous to make examples of those they believe are trying to cheat the system.
Because the medical industry loses billions of dollars to scams and fraud each year, if you are facing criminal charges for health care fraud, you will likely deal with federal agencies like the FBI as well as California authorities and insurance investigators. You have a lot on the line since penalties for health care fraud can be steep and life-altering.
Countless chances for mistakes
A busy medical facility, confusing paperwork or complicated billing procedure can create a perfect storm for honest mistakes. Nevertheless, authorities may bring the hammer down hard if they believe you have intentionally misused some aspect of the medical industry for your own gain. Health care fraud occurs among medical professionals, insurance agents and regular citizens, so no one is under the radar of federal agents who are on the alert for the following violations:
- Billing an insurer twice for the same service
- Billing for a procedure you did not perform
- Billing for each separate phase of a procedure that usually counts as one service
- Billing for more costly services than what the patient received
- Selling or distributing medications without a prescription
- Receiving kickbacks for patient referrals
- Providing and charging for medical services without a valid license
Of course, identity theft is often a large factor in health care fraud. If authorities believe you used someone else’s identity or insurance information to commit fraud, your legal situation may be even more complex and the stakes even higher. Additionally, with the growing rates of addiction and overdoses across the country, prescription crimes like doctor shopping, diversion and forging prescriptions can carry hefty penalties for a conviction.
If you or your medical facility is under investigation for health care fraud of some kind, your future may be on the line. A conviction for health care fraud may include numerous years in prison for each count, costly fines and the potential loss of your professional license. These can be a tremendous burden for a violation that may have been the result of an honest mistake or simple oversight.