When Healthcare Fraud becomes a Crime

by tylercook on May 9, 2013

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Healthcare fraud is a growing concern in the United States. It cost approximately $80 billion dollars a year to taxpayers. Law enforcement officials work feverishly to put a stop to healthcare fraud, but, there is a limit to what they can do. Healthcare fraud is the act of filing false claims to the insurance company. Doctors and patients can both be found guilty of this type of fraud. Doctors who commit the crime willfully misguide patients, putting the patient at serious health risk.

When does Healthcare Fraud become a Crime?

Healthcare fraud is a crime from the moment that anyone conspires to do so. Just as conspiring to murder someone or rob a bank are crimes, so is conspiring to commit healthcare fraud. Conspiracy results in lower penalties than actually committing the fraud. It can still result in a great deal of jail time for anyone who considers it.

Healthcare fraud is committed by weaving a sophisticated web of lies in order to dupe insurance companies out of money that is never used for actual healthcare. Various charges can result from the act including theft, fraud, and conspiracy to commit fraud. There are serious repercussions for each charge including fines, prison sentences, and restitution.

How do Insurance Companies know Fraud has been Committed?

Insurance companies are painfully aware that fraud is committed on a daily basis. In order to keep healthcare cost to a minimum, health insurance companies hire private investigators to insure that claims are legitimate. All claims are not investigated; however, some cases raise red flags and therefore require the help of a professional investigator.

The private investigator records video and photos of the suspect in order to prove the case in court. If a doctor is under suspicion of defrauding an insurance company, an undercover detective may find a way to penetrate the practice in order to establish that fraud has been committed and the extent to which it has occurred. That is when the bulk of proof is gathered for prosecution.

Is Healthcare Fraud a Felony Offense?

There are state and federal laws regarding healthcare fraud. The severity of the crime determines which court will prosecute the offender. State laws vary from one place to another. It depends on what state the fraud was committed in as to whether it is charged as a felony offense. Felony offenses remain on the record for the rest of the offender’s life. Felonies cause inability to find gainful employment, negatively affects the credit rating and can even cause auto insurance rates to rise. A doctor accused of the crime will find their license suspended. If convicted, the doctor will lose his or her license to practice medicine.

Healthcare fraud is the cause of high insurance premiums for everyone. Each time someone commits the crime, rates are likely to go up to offset loss to the insurance company. When doctors commit a crime that puts the health of patients at risk, they go against the very oath that they swear by when they become physicians. It is a betrayal of doctor/patient trust that can never be recovered.

People who consider committing a healthcare fraud may not understand the full impact of their actions. Once the fraud is uncovered, it destroys the life of the offender, his or her family, and the population in general. A reputation takes years to build and moments to disintegrate. Weaving a web of deceit never works out for anyone because there is always someone there to dismantle it.

Byline: Brad Colson believes that whether it’s Medicaid or Medicare Fraud, it must always be treated as a crime in order to protect the health and livelihood of patients.




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