When an individual intentionally deceives a healthcare provider, insurance company, or government program to obtain money or services illegally, there can be harsh consequences. This is healthcare fraud, and understanding this offense is crucial for anyone working in the field.
What is healthcare fraud?
Our healthcare system is complicated and constantly changing. As such, people can and do make poor decisions and mistakes while navigating this system. Some examples of healthcare fraud include:
- Medical identity theft (using another person’s credentials to obtain information)
- Falsification of medical records
- Billing for unnecessary services or items
- Billing for services or items not rendered
- Upcoding (overcharging for a specific service more than its value)
- Unbundling (charging a patient for a packaged service separately to increase income)
- Getting kickbacks
Fraud in healthcare may cause premiums to increase and strain the resources available for those who need it. Because of the impact these acts have on others, federal and state officials devote massive resources to investigating claims and pursuing penalties, which can be incredibly intimidating and upsetting.
How severe is the punishment for healthcare fraud?
In Michigan, involvement in a healthcare fraud scheme is considered a federal offense and may result in serious penalties. A person could face imprisonment in addition to potential criminal fines, a term of supervised release and mandatory special assessment.
Generally, the higher the damage amount, the harsher the sentence.
For instance, one psychiatrist pleaded guilty to a fraud scheme that gave patients false psychiatric diagnoses, which resulted in more than $20 million in disability payments. As a result, the courts ordered him to pay $50 million in restitution and sentenced him to federal prison.
If you are facing charges related to healthcare fraud or are under investigation, allegations for this type of offense can jeopardize your professional reputation. Healthcare fraud is a complex area of the law, and you may want to seek legal guidance to pursue the dismissal of charges or reductions in penalties and sanctions.
