Allegations of healthcare fraud can impact anyone associated with the medical world, affecting hospital directors, doctors, nurses and even business owners who sell goods to those in healthcare. Healthcare professionals can find themselves under government scrutiny for an array of potential issues. Some common examples include:
- Billing for services not rendered: This occurs when claims are submitted to insurance companies for procedures or treatments that the government claims the medical provider never actually provided.
- Upcoding services and procedures: In other cases, the government will claim providers billed for more expensive services than those actually performed, a practice known as upcoding.
- Performing unnecessary services: The government may also argue that in an effort to increase revenue, practitioners performed unnecessary procedures or tests that were not medically justified.
These accusations can result in serious ramifications for the accused individual’s professional and personal life.
What are the possible penalties for healthcare fraud?
The penalties for healthcare fraud can be severe and vary depending on the details of the allegations but often include hefty fines, restitution, and even imprisonment. In a recent example, the court sentenced a man out of Mount Pleasant to almost a decade imprisonment for his role in a healthcare fraud scheme involving medically unnecessary medical equipment orders. The government gathered evidence to support a claim that the accused, a business owner of at least ten companies, billed Medicare for medically unnecessary braces.
It is important to note that in addition to navigating the allegations of criminal wrongdoing, healthcare professionals can also find themselves facing reputational damage and may find their professional license at risk. As such, those who find themselves facing similar allegations of wrongdoing are wise to gather evidence to help support their claims. This can help to prove that billed services were provided as claimed and were medically necessary.
Healthcare fraud investigations are frustrating. By understanding common triggers and implementing robust defense strategies, healthcare providers and those who operate in this market can protect themselves when navigating the accusations and maintain their focus on patient care and business operations.