Criminal Law - Federal

Health Care Fraud

Heath care fraud is a federal crime and usually a pretty serious offense that can carry steep penalties.

It will be important to take immediate action to build your defense if you're charged with health care fraud. Everything you say and do early on in the investigation or trial could impact your case, so it's essential to know what your charges mean and how you might be able to fight them.

What is Health Care Fraud?

Health care fraud is a fairly broad term that covers many illegal actions. The most common types of health care fraud are related to billing insurance companies or individual patients, including:

  • Overcharging for a service, like inflating prices or adding costs for individual parts of a bundled treatment
  • Recommending unnecessary medications or procedures in order to bill for them
  • Charging for a name-brand medication but providing the generic
  • Invoicing insurance companies for patients who were never seen, usually through some type of identity theft
  • Mislabeling services to get insurance to pay for procedures that normally aren't covered
  • Lying about when or where a procedure occurred

These kind of health care frauds are often considered Health Insurance Portability and Accountability Act (HIPAA) violations. Insurance fraud can relate to either government programs, like Medicare and Medicaid, or to private insurance companies. Not only is actually committing health care fraud a crime, you could be charged with conspiracy to commit fraud, even if you haven't actually done anything illegal yet.

What are the Penalties for Health Care Fraud?

Because health care fraud involves violating federal laws, it's usually charged as a federal offense, though individual states may have their own rules and penalties you may have to contend with on top of the federal ones. The Federal Bureau of Investigation (FBI) is the unit most likely to take charge of collecting the evidence against you for the federal charges.

You'll mostly likely have to go to court and have a criminal trial, unless you plead to the charges beforehand. While state penalties will vary, federal penalties include fines, which are usually charged per violation to the tune of over $200,000 each for the people who committed them. Businesses can receive additional fines if their employees engage in fraud.

People who commit health care fraud also face a few years of jail time, depending on the severity of their actions. Medical providers who commit the fraud could lose their licences to practice medicine. Businesses that have employees committing health care fraud could be shut down, or just priced out of operation by the exorbitant fines.

What Do I Do if I'm Charged with Health Care Fraud?

It is likely critical to the presentation of your case to hire an experienced attorney who knows how to handle health care fraud cases. Because these are serious crimes with severe penalties, building a good defense could mean the difference between a devastating conviction with a maximum sentence or a lesser sentence to possibly acquittal entirely.

An attorney may even be able to get the charges decreased to lower your overall exposure. Before and during your trial, you'll need to behave as professionally as possible and avoid any other entanglement with fraudulent practices. Knowing what to say and what to do will help your case immensely, which an attorney can help you with.