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The crime of healthcare fraud

On Behalf of | Feb 13, 2023 | Federal Crimes, Health Care Crimes |

Being charged with healthcare fraud in Florida is frightening for anyone. If it happens to you, you have the right to defend yourself. These are some facts to know about it and how common a problem it is.

Understanding healthcare fraud

Healthcare fraud is a federal offense that involves intentional deception for unlawful gain within or from the healthcare industry. It can be perpetrated by doctors and other healthcare professionals for financial gain or by individuals looking to gain healthcare benefits they are not due.

According to the National Health Care Anti-Fraud Association, around $68 billion is lost each year as a result of healthcare fraud. The crime harms the healthcare industry, insurance companies and taxpayers. Unfortunately, it is very common and only continues to rise each year.

Common examples of healthcare fraud

There are many ways that healthcare fraud can be committed. If a doctor or other medical provider is involved in the crime, it can occur through double billing, phantom billing, upcoding or unbundling. Double billing is self-explanatory while phantom billing means billing for services that were never rendered. Upcoding relates to charging more for services and unbundling involves multiple bills for one service.

Individuals can commit healthcare fraud through identity theft and using another person’s health insurance or when someone allows another person to use their insurance. It can also occur when someone is involved in a fraudulent marketing scheme to gain another person’s information or fool them into signing up for fake benefits.

Healthcare fraud can also occur when prescriptions are involved. For example, a person with substance use disorder steals a doctor’s prescription pad to write out a prescription for drugs.

As a federal crime, healthcare fraud carries serious repercussions and penalties. Such charges should never be taken lightly.