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Healthcare fraud happens when a deceitful provider or consumer deliberately submits or causes someone else to present false or deceptive information for use in determining the number of healthcare benefits allocated.
Acts which may be considered healthcare fraud include:
- Billing for services was never performed.
- Upcoding – billing for a more costly service than the service that was performed
- Unbundling – billing each stage of a procedure as if it were a separate procedure
- Waiving patient co-pays or deductibles, and over-billing the insurance carrier or benefit plan
- Over-prescribing controlled medication
- Misrepresenting procedures performed to obtain payment for non-covered services, such as cosmetic procedures.
- Billing a patient more than the co-pay amount for services that were prepaid or paid in full by the benefit plan under the terms of a managed care agreement
- Falsifying a patient’s diagnosis to give a reason for tests, surgeries, and/or other procedures that are not medically required
- Internet pharmacy violations
- Accepting kickbacks for patient referrals
- Filing claims for services or medications not rendered.
- Forging or changing bills or receipts
- Use of someone else’s insurance card or coverage
Who Investigates Health Care Fraud?
The Federal Bureau of Investigation (FBI) primarily investigates health care fraud with jurisdiction over federal and private insurance programs and non-insurance health care fraud matters.
The FBI examines these federal crimes to identify critical components into investigations partnering with the federal, state, and local agencies.
Possible penalties include:
- Extremely high fines and fees
The sentences for even minor violations can be extensive, including professional sanctions and the loss of your professional license, in addition to federal criminal charges.
In addition, Healthcare fraud cases may involve many complicated financial matters and an extensive investigation.
There could be several issues to review through medical and financial records for errors or attempted fraud.
These are some reasons why it is imperative that you retain an experienced healthcare fraud attorney in Miami to fight on your behalf.
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