By: LINDSEY O’NEILL, ESQ.

What is Health Care Fraud? Health care fraud occurs when health care professionals make false or misleading statements in order to benefit financially. Health care schemes are diverse and often complex.

Examples include overbilling, billing for services not even provided, double billing for the same procedure, billing for a more expensive procedure than actually performed, or billing separately for items that are less expensive when bundled together (for example a group lab tests). It is also fraudulent to receive a “kickback” for referring a patient to another doctor. Doctors have even been caught selling prescriptions to patients for cash.

Part of the reason health care fraud is so prevalent is because health care is so expensive and is such a massive system. It is not unusual for a carrier to cut a check for over $100,000 to someone it does not even know! Because it is so prevalent, billions of dollars are being drained from the Medicaid and Medicare Industries on fraudulent claims. Scam artists often close up shop and flee before investigators can even attempt to recover the fraudulently obtained funds.

However, the Justice Department has made health care fraud a top priority. Many investigations are the result of complaints from patients and the public at large. Because fraud is conducted for the most part “in secret” these tip-offs from health care consumers are extremely valuable to the FBI and other law enforcement officials. Criminal penalties for health care fraud can be very severe. If you are involved in a health care practice you believe may be considered fraudulent, contact an attorney for more information.