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Healthcare Fraud: What Is It?

In a criminal healthcare fraud case, the fraud victims are either insurance companies or the government, which, in this case, is Medicare or Medicaid.

The Federal Bureau of Investigation (FBI) estimates that $80 billion in healthcare fraud occurs every year. The principal agency with the task of investigating and exposing healthcare fraud in the public and private sectors is the FBI.

When you discover you’re under FBI investigation, contact a criminal defense attorney immediately, because your best defense is to prevent indictment. An experienced lawyer should be at your side during any questioning.

Healthcare fraud takes on many forms, according to the National Health Care Anti-Fraud Association. Both individuals and healthcare providers can commit healthcare fraud. Typically, the individual falsifies information when applying for a healthcare policy. However, healthcare providers commit the majority of healthcare fraud. In fact, the losses from provider healthcare fraud are not just monetary. Providers often subject patients to unnecessary or unsafe procedures, exploiting them for financial gain. Signs of healthcare fraud can include:

  • Performing unnecessary medical services for the purposes of billing
  • Upcoding, which means billing for more expensive services than the ones done
  • Misrepresenting treatments as medically necessary when they are not normally covered treatments
  • Falsifying a diagnosis to justify unnecessary medical surgery or treatment
  • Billing procedures separately instead of together to obtain more money
  • Billing patients for copay amounts that were fully paid or prepaid by the benefit plans
  • Taking patient referral kickbacks

When charged with healthcare fraud in Florida, the best way to protect your rights, whether you’re an individual or healthcare provider, is to work with an experienced criminal defense law firm.