Kushner Law Group, PLLC
Kushner Law Group, PLLC
Vigorous Advocates Fighting For Your Rights

What is healthcare fraud and how does it happen?

On Behalf of | Dec 24, 2022 | White Collar Crimes |

Healthcare fraud is one of the most prosecuted white-collar crimes in the U.S. Basically, you can be charged with healthcare fraud if you provide false or misleading information to a health insurance provider with the intention of making unauthorized benefits claims on behalf of the policyholder or your clinic.

If you are charged with healthcare fraud, you need to explore your defense options. However, to effectively fight the charges and defend yourself, it helps to understand how healthcare fraud happens in the first place.

Here are three common types of healthcare fraud that you should be aware of.

Offering or accepting kickbacks

Kickbacks are not uncommon in the healthcare industry. Generally, it is illegal for a healthcare provider or the hospital to receive anything of monetary value like equity, cash or gifts from another healthcare provider, medical equipment manufacturer or distributor, drug company or any other favor in order to refer patients at certain fees or meet certain targets.

Providing unnecessary medical services

Medicaid can only offer reimbursement for eligible claims. Additionally, the procedure in question must be medically necessary. If you prescribe procedures or treatment plans that are barely related to your patient’s condition or are totally irrelevant, then suggestions may be deemed to be in violation of the healthcare rules and, hence, fraudulent.

Upcoding

This is, perhaps, the most common type of healthcare fraud. Basically, upcoding involves billing for medical services that were never provided or billing for a more expensive service when, in a real sense, a cheaper service was provided. If your patient’s bill does not match up with the service they received, then there is a pretty good chance your facility is engaging in this illegal billing practice.

Healthcare fraud is a serious form of white-collar crime with far-reaching legal consequences. Find out how you can defend yourself and safeguard your rights and interests if you or your clinic is accused of healthcare fraud.