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Types of healthcare fraud

On Behalf of | Dec 5, 2022 | Criminal Defense

Rhode Island physicians and healthcare professionals rely on patients’ insurance coverage for payment. Unfortunately, some engage in healthcare fraud that could open them to criminal charges.

Forms of healthcare fraud

Among the most common examples of healthcare fraud is false billing. False billing refers to various actions intended to claim undeserved payments. For example, a doctor’s office may bill an insurance company for work never performed.

False billing could take other forms, such as ordering tests or procedures that are not necessary. Sometimes, double billing occurs, which is also fraudulent.

Overcharging for medical supplies and items may lead to claims of healthcare fraud. Charging Medicare five times the price for orthopedic shows might leave someone in serious legal trouble.

Dealing with claims of fraud

Since Medicare is a government program, those accused of Medicare fraud could face federal charges. When a private insurance company is the victim of fraud, the charges could be on the state level. Some cases may involve fraud perpetrated against Medicare and private insurers.

A criminal defense in Rhode Island could point out that fraud requires intent. In the healthcare profession, events that look like fraud might be grossly negligent mistakes. A healthcare provider might accidentally send the same bill for the same procedure twice. Such actions may be negligent, but they could fall well below the legal definition of criminal fraud.

Also, the entity accusing someone of fraud could be mistaken. A defense strategy could prove that the accusations are not true. Whether the accusations are true or not, the accused has rights. The evidence might be inadmissible if law enforcement performed illegal actions to build a case.

Healthcare fraud takes many forms. No matter the specifics, fraud remains a serious criminal charge.