If you, a group of people or a company knowingly misstates or misrepresents something about the nature, scope or type of a medical service provided, healthcare fraud occurs. This often results in the insurer or company making unauthorized payments to receive a financial kickback.
According to the U.S. Department of Justice, healthcare fraud can occur with any type of insurer or health insurance company, including Medicaid, Medicare, private insurers and workers’ compensation providers. Healthcare fraud can also impact hospital care, home healthcare, skilled nursing care, physician services, x-rays, outpatient services and any other type of medical service rendered.
Some examples of healthcare fraud include:
Healthcare fraud can also include misrepresenting charges in accounting reports and soliciting kickbacks in exchange for different goods or services provided.
You have to establish “fraudulent intent” for a healthcare fraud case to move forward in court. Depending on your case, you could argue that you did not act in bad faith or that you made an innocent error when creating medical documents or providing services.
For instance, if you face charges for over-billing an insurance company, you could argue that someone else in your office made a clerical mistake. Or you could state that the billing was appropriate in your professional opinion.
For personalized legal guidance, call our office at 417-882-9300 or submit this form to schedule a meeting with an attorney.