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Who commits health care fraud?

On Behalf of | Dec 6, 2022 | Firm News |

In Washington, health care fraud can be a problem. Conservative estimates show that across the United States, this type of fraud adds up to more than $68 billion annually. Generally, law enforcement divides medical fraud into three large categories.

Fraud committed by providers

Providers can commit health care fraud by double billing, falsifying treatment plans, misrepresenting diagnoses and billing for seeing patients they never saw. They may also not bill the correct services together or bill for services separately that they should group. For example, in 2021, the Department of Justice announced that a former CEO of a group of hospice and home health facilities was given 15 years in prison for offering health care providers money for signing up their patients for hospice care when they would otherwise not qualify. Furthermore, he was found guilty of telling patients they would die within six months when medical facts did not support that.

Fraud committed by patients and other individuals

Patients and other individuals can also commit health care fraud and need criminal defense. This can happen when someone uses someone else’s health insurance to receive care. Fraud also occurs when a company makes false threats to force someone to give them their Medicare or Medicaid numbers. It can also happen when someone claims to be a medical provider with no license. For example, a home-health worker was charged with obtaining over 9,600 pills containing oxycodone using 10 different people’s medical information. Law enforcement officials believe she went to at least four pharmacies with 80 forged prescriptions over 11 months.

Prescription Fraud

Prescription fraud can happen in many ways. Providers can write prescriptions that they fill and sell on the street. It can also occur when a person claims to be someone else to get an insurance company to pay for a prescription. Finally, it can be when a person uses multiple doctors to get the same medication.

Medical fraud can take on many forms. Review your information often to make sure you are not a victim.