Fraud in any form committed against the health care system is a serious criminal offense, and it can result in steep penalties for those convicted of it. The federal government typically prosecutes health care fraud cases to the fullest extent of the law as estimates show that this type of crime results in approximately $60 billion in losses each year. As this is a federal offense, it can result in lengthy prison sentences and other consequences that have the potential to alter a California defendant’s entire future.
If you are under investigation for health care fraud or you are facing formal charges for this type of white-collar crime, you will benefit from understanding more about the case against you. This will help you prepare an effective defense strategy that allows you to confront the prosecution’s case. Health care fraud cases are complex, and but you do not have to navigate this difficult process alone.
What is health care fraud and abuse?
Fraud involves any act committed with the intent of financial gain or theft. In health care fraud schemes, fraudulent activities often involve different insurance billing practices or other activities designed to collect more money from the insurance company. Specific ways this can happen include:
- Misrepresentation of the person providing the health care service
- Misrepresentation of the type of services provided
- Billing for services not properly documented
- Billing for items or services not actually rendered
- Billing at a higher rate for services worth a lower amount
Like fraud, abuse happens by taking certain actions that are not consistent with sound financial or medical practices. This results in fraudulent billing by misrepresenting costs, billing for unnecessary medical services or providing services that do not meet a certain standard for health care. This may include:
- Charging excessive rates for services or supplies
- Misusing codes for a claim
- Billing for medically unnecessary services
Instances of health care fraud or abusive billing practices can result in federal charges. If you are in this situation, you will benefit from learning about the defense options available to you as soon as possible. With a carefully developed strategy, you can fight to prove the alleged fraud was a simple mistake or there was intent to defraud. Your future could be at stake, but your quick action will allow you to develop a strategy by which you can fight for your freedom and interests.