What Are Some of the Most Common Forms of Healthcare Fraud?

By Brock Benjamin
Founding Attorney

Healthcare fraud, a subcategory of fraud, has gained more attention in recent years. Generally speaking, healthcare fraud involves intentionally misrepresenting or deceiving a healthcare provider, a patient, or a health insurance provider in order to obtain benefits. Both state and federal laws are often implicated in healthcare fraud. The penalties can be severe and wide-ranging. 

Healthcare fraud often involves defrauding government programs, such as Medicaid, or big insurance companies for money. Because of the power behind the entities being defrauded, those facing healthcare fraud charges are likely to find no mercy. The prosecutor will likely throw the full weight of the law and vast resources to secure a conviction and impose steep penalties. If you are facing healthcare fraud charges, get dedicated criminal defense counsel as soon as possible.

What is healthcare fraud?

Healthcare fraud often involves defrauding an insurance provider. For instance, an individual or business may furnish false information to an insurance provider when applying for health insurance or filing a claim. An individual may try to falsify an insurance claim in order to access policy benefits. Health insurance fraud also includes using someone else’s insurance card in order to obtain healthcare services.

Medicaid Fraud

Another common form of healthcare fraud involving health insurance is criminal Medicaid fraud. Medicaid is a medical cost-sharing program administered both at the Federal level and by the State of Texas. The Medicaid program helps provide healthcare benefits to low income individuals. The government is particularly serious about Medicaid fraud. If convicted of Medicaid fraud, the defendant stands to face extended periods of incarceration and substantial fines. It is also likely that they will lose their status as a Medicaid provider. Providers may be found guilty of Medicaid fraud if they have been billing for brand name prescriptions when, in fact, they distributed the generic version to patients. Additionally, a medical provider may be found guilty of Medicaid fraud for billing for care that was never given or sending multiple bills to patients for medical services that were already paid for by Medicaid.

Improper Billing

Improper billing by a provider is also a common subcategory of healthcare fraud. For instance, a provider may attempt to increase profits through unbundling. Usually, certain medical treatments and procedures are bundled by healthcare providers in an attempt to reduce the cost to patients. When a provider unbundles these services, they are billing separately for different parts of a single procedure in an attempt to recover more money from the patient. Additionally, providers will sometimes upcode. Upcoding happens when a patient is billed for a more expensive service than the one he or she received from the provider. Both unbundling and upcoding are seen as forms of healthcare fraud.

Criminal Defense Attorney

As you can see, both patients and medical providers can be charged with a healthcare fraud offense. In either case, the penalties can be severe. Penalties include incarceration, fines, and loss of medical licensure. With this much on the line, you need to secure trusted criminal defense counsel by your side as soon as possible. The Benjamin Law Firm is dedicated to zealously advocating on behalf of our clients. We fight for you against all charges. Contact us today.

About the Author
Brock Benjamin is board-certified in Criminal Law by the Texas Board of Legal Specialization.  His practice is primarily state and federal criminal law and appeals.Brock 

Posted in: Healthcare Fraud, White Collar Crimes