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Frequently Asked Questions About Healthcare Fraud

Frequently Asked Questions About Healthcare Fraud

The cost of healthcare has become truly unaffordable, and laws are beginning to change to limit the amount that patients must pay for necessary medical services. A big part of the problem is the confusing system of medical billing; to say that there is a widespread lack of transparency related to medical insurance claims is an understatement. Doctors and insurers are allowed to negotiate about prices, and in some cases, they are required to; you are not going to get in trouble for getting an insurance company to write off part of the cost of a treatment you performed. If you intentionally make false statements to a health insurance company or a publicly funded insurer such as Medicare, Medicaid, or Tricare, though, you can face criminal charges for healthcare fraud. If you are a healthcare provider being accused of healthcare fraud, contact a Texas federal crimes lawyer.

Which Laws Govern Healthcare Fraud?

Some crimes, such as theft or simple assault, are governed by specific statutes. Conversely, healthcare fraud is a category of crime, rather than a specific criminal offense. If a healthcare provider is accused of defrauding Medicare, Medicaid, or private insurance companies, he or she might get charged with wire fraud, mail fraud, or paying or receiving kickbacks, among other offenses. If you file fraudulent claims with a publicly funded program such as Medicare or Medicaid, you could also be accused of violating the federal False Claims Act.

Which Unethical Actions Count as Healthcare Fraud?

Anytime doctors knowingly make false statements to insurers or other parties responsible for payment in an effort to enrich themselves, they could be charged with healthcare fraud. These are some actions that could qualify:

  • Falsifying patients’ medical records to make it look like they received services they did not receive
  • Ordering unnecessary diagnostic tests or medical devices or prescribing unnecessary drugs
  • Billing insurance companies for treatments that were never administered
  • Requesting or receiving money from specialists in exchange for patient referrals
  • Making false statements on insurance claims
  • Billing separately for a set of tests or treatments when they would cost less if bundled

What Are the Penalties for Healthcare Fraud?

If you get convicted of healthcare fraud, your penalties could include a prison sentence and criminal fines. The criminal court might also order you to pay restitution to the parties that you defrauded, and the civil court might impose civil fines for healthcare fraud. You could even lose your medical license.

What Are the Possible Defenses to Charges of Healthcare Fraud?

You can only be convicted of fraud if you actually made the statements you are accused of making and if you knew that the statements were false. You cannot be convicted if the evidence against you is fabricated or if you genuinely believed that the statements you made were true.

Contact the Law Office of Patrick J. McLain, PLLC About Healthcare Fraud Charges

A criminal defense lawyer can help you if you are facing criminal charges for Medicare fraud or some other kind of healthcare fraud. Contact the Law Office of Patrick J. McLain, PLLC in Dallas, Texas to discuss your case. 

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