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Former Assistant District Attorney
Former Assistant U.S. Attorney

What is health care fraud?

On Behalf of | Apr 15, 2020 | Federal Crimes

Mississippi healthcare professionals or members may hear of penalties for health care fraud. But do you know the true severity of these penalties?

Today we will look at the definition of health care fraud. We will examine examples of this fraud. We will look at the penalties faced by convicted people.

Practitioner’s health care fraud

The Cornell Law School gives an overview of what health care fraud is. The law categorizes it as a white collar crime. It involves filing health care claims that are untrue. The person accused of health care fraud does this to turn a profit.

There are many different forms of health care schemes. First we will look at some examples on the practitioner’s side. One includes unnecessary fully-covered prescription pills to sell on the black market. Another example involves practitioners billing clients for services that they did not provide. They may file duplicate claims for the same service. Some use unlicensed staff. Others may alter dates, medical records or personal identifying information.

Member’s health care fraud

Members can also commit health care fraud, though. For example, they may sell or forge prescription drugs. They may apply to services or programs with false information. They may loan their insurance card out to someone else, or use the insurance card of another person. They may also use transportation benefits for reasons that are not medical.

Health care fraud comes with the possibility of a severe penalty. This is also a problem of unfortunate proportions. According to some sources, every 10 cents to a dollar in health care goes to fraudulent claims.

If convicted of a health care fraud crime, you face the possibility of time in jail. You may suffer from heavy fines and fees. In some cases, medical practitioners even lose their license. These consequences can be devastating to a person’s life and livelihood. This is why proper defense when facing these crimes is key.