Health Care Fraud

Health Care Fraud Cases

Health care fraud is a crime, and it’s much more common than many people might think. Unlike other forms of fraud like credit card fraud, health care fraud also adds the additional element of physical danger. A person’s health can be affected in addition to financial consequences. It’s important to learn about current or previous health care fraud cases so you can better protect yourself, and, most importantly, your health.

What Is Health Care Fraud?

Health care fraud involves providing false information to affect the distribution of medical payments or services. This can be perpetrated by a dishonest medical provider or by a third person using another’s medical information to gain access to their benefits. There are many ways in which health care fraud is committed, both by providers and from the consumer end. Each can have serious consequences.

Types of Health Care Fraud

Medical Providers

Medical providers have access to a great deal of information and resources. The vast majority of providers perform their jobs honestly and within the boundaries of the law. There are some, however, who use the system to benefit themselves or others unlawfully. One form of health care fraud takes place when a provider bills for services not provided. They get reimbursed by insurance companies or Medicare without having rendered those services. They can also bill for services other than those performed to get reimbursed when the services actually provided are not covered. This can include things like cosmetic surgery that is not medically necessary. There are also cases of health care fraud involving paying kickbacks for providing or receiving referrals. Patients can prevent these activities from happening by thoroughly reviewing medical bills, their insurance policy, and their Explanation of Benefits (EOB), and only signing off on procedures after they are explained and written out.

Consumers

Health care fraud is also committed by consumers when they present false information to determine the benefits received. This includes submitting claims for procedures or services not received. It can also include altering or forging medical bills in order to get access to greater or different health care benefits. A particularly dangerous form of health care fraud involves a consumer using another person’s health insurance to receive care or benefits. Not only is the victim then billed for services obtained by someone else, but the victim’s medical history can then have that information added to it, which could lead to the wrong care being provided in the future. To avoid becoming a victim of health care fraud, it’s important to be vigilant. People should be sure to read all bills and associated information. It’s a good idea to only sign off on one procedure at a time to be sure all billed services are understood. Most importantly, it’s imperative that people be very cautious about giving out their health care and insurance information. This should only be given to known and trusted providers or companies. Additionally, people should be cautious about offers for free trials of medications or other services. These offers can be associated with fraud and should be discussed with a trusted health care provider.

Examples of Health Care Fraud Cases

Just last year in California, officials arrested nine defendants in “Operation Spinal Cap,” in which $1 billion in fraudulent claims were filed. In this health care fraud case, a private hospital owner paid over $40 million in kickbacks to other doctors for referrals for services to be performed in his hospital. Several other providers were arrested and charged for similar activities. In another health care fraud case, a Houston physician was arrested for illegally distributing opioids shipped from Los Angeles to Texas. This is another instance in which health care fraud can be dangerous to the health of others, particularly in light of the ongoing opioid crisis.

Health Care Defense Attorneys

With so many types of fraud being committed, there can also be instances in which innocent people need to be defended against similar charges. In cases of mistaken identity or entrapment, it’s important to have a skilled attorney on your side. Contact Bradley Corbett to learn more about health care fraud and available services.

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