Health care fraud is a serious crime. It involves intentionally deceptive or illegal activity committed by a person in the health care industry. It often involves fraud for personal financial gain.
Health care fraud overview
Some of the most common examples of health care fraud are billing for services not provided or for unnecessary services, overbilling for services, submitting false claims and prescribing unnecessary medication.
Depending on the offense, the penalties for health care fraud can differ. The accused may face criminal fines that can range from thousands to millions of dollars. They may also be subject to jail or prison, which in some circumstances can extend to decades behind bars.
They may also be required to repay any money they obtained through the fraud, can lose their license or professional credentials and can be excluded from participation in federal healthcare programs such as Medicare and Medicaid.
Potential defenses
The accused person may have several defenses available to them. If the accused person did not intentionally engage in fraudulent activity, they may be able to argue that they lacked the required intent for the crime.
Also, if they make an error or an honest mistake, usually regarding a billing error, they may be able to use that as a defense. They may also be able to avoid conviction if they can show that they were following all applicable regulations when submitting bills for payment.
A conviction of health care fraud can have a significant impact on the accused’s reputation, both personally and professionally, but there are options available to clear their name.