There are two primary forms of healthcare and medical fraud that take place in the United States. Healthcare providers may bill government agencies and insurance providers for services and drugs that were never implemented or used. Or they may provide services to patients that are not actually needed. Individuals may also commit fraud by claiming that certain procedures took place in an effort to be reimbursed for services they never had to pay for.
Specifically, healthcare fraud can take place if dates, locations and providers of service are misrepresented, falsifying a diagnosis to justify treatments, tampering with medical records, forging signatures, or falsifying billing procedures, among many others.
Prosecuting Healthcare and Medical Fraud
The government prosecutes many perceived violators under the False Claims Act, when someone files a fraudulent claim attempting to collect money related to health care. Penalties can range up to $10,000 for each false claim in addition to seeking repayment of up to three times the actual damages suffered by the federal government. The False Claims Act also deputizes private citizens by allowing them to sue perpetrators of fraud on behalf of the federal government. If a person becomes aware that healthcare fraud is taking place and they sue, they can collect up to 30 % of any funds that are recovered.
Defending against healthcare fraud charges
The healthcare industry is one of the most regulated of all industries. That means there are scores upon scores of regulations and compliance requirements that must be met at all times. Because of this, disputes and misunderstandings can take place quite frequently. In many cases, it may be possible to keep a dispute out of court and out of the public eye by finding a way to settle a case. At other times, a strong defense may be needed to meet the considerable resources of a governmental investigation.
If you are facing a complicated situation that may lead to healthcare or medical fraud charges, it is best to contact us as soon as possible to discuss your options.
The Law Office of Ginger Kelley serves clients in Newport Beach, Santa Ana and communities throughout Orange County, California.