Healthcare Fraud Basics to Understand

Fraud related to Medicare and healthcare can result in serious penalties and consequences, which is why it is important for individuals accused of this to understand what their defense options are. In general, healthcare fraud is a type of white collar crime that involves filing dishonest health care claims to make a profit.

Fraudulent Healthcare Schemes

There are a variety of fraudulent healthcare schemes including those medical care providers may be accused of. Examples of fraudulent healthcare schemes include obtaining prescription pills that are subsidized or fully covered and unneeded and then selling them on the black market for a profit; prescribing additional or unnecessary treatments; billing for care that was never rendered; filing duplicate claims for the same services rendered; altering dates or descriptions of services; altering identities of members or providers; billing for services that are not covered as covered services; modifying medical records; intentionally reporting incorrect diagnoses or procedures to maximize payment; using unlicensed staff; acceptance of kickbacks for member referrals or waiving member co-pays.

In addition to practitioner healthcare fraud, the different types of member fraud include providing false information when applying for Medicare programs or services; illegally selling prescriptions drugs; inappropriate use of an insurance card and in other circumstances as well.

Potential Penalties And Consequences

Health care providers who are facing healthcare fraud accusations and allegations can face incarceration, fines and other potential penalties and consequences which is why they should be aware of the legal defense options available to them. Facing healthcare fraud accusations alone can be overwhelming, which is why trained guidance may be useful for those facing such claims.

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