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Examples and Elements of Health Care Fraud

On Behalf of | Dec 3, 2022 | Health Care Crimes |

Florida authorities may pursue criminal charges against individuals for healthcare fraud, which is a subset of white-collar criminal fraud. The most basic healthcare fraud cases might involve a person simply gathering patient information and sending fraudulent bills to be paid by insurers, Medicare or Medicaid. It is not uncommon for physicians and billing companies to be involved in health fraud cases for overbilling or fraudulent billing.

Health care fraud Senate testimony

The Department of Health and Human Services and the Office of the Inspector General have recently given testimony about health care fraud before the U.S. Senate. Among the cases was a home pharmacy that rebilled for drugs after the originally intended patients had died or ended their treatment, a Medicare provider that gave a false address in the middle of the Miami airport and a supplier that billed Medicare more than 25 times the acquisition cost for adult diapers.

Teaching hospitals engaged in health care fraud

While many of those accused of health care fraud are for-profit companies, many non-profits have also been involved in fraudulent schemes. The University of Pittsburgh School of Medicine, for example, recently settled a healthcare fraud action for $17 million. Yale University, Southern Illinois University and the University of Texas have also recently agreed to settlements as a consequence of healthcare fraud audits or self-audits.

Elements of criminal health care fraud

The elements of a cause of action for health care fraud include the making of a material misrepresentation, an awareness that the claim is false, an intention to benefit from the false claim and the reliance of another party on the false claim. Additionally, the other party must suffer harm, financial or otherwise, due to their reliance on the false claim. If these elements are established, there may be grounds for a conviction of healthcare fraud.