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Health care fraud is a general term for fraud perpetrated by individuals in the health care profession and industry, including physicians and large publicly traded companies, medical equipment dealers, contract carriers for Medicare and Medicaid, laboratories, hospitals, nursing homes, and home health care agencies.
Health care fraud schemes are diverse and vary in complexity, targeting both public and private health insurance plans. Examples include:
Billing for services not rendered
Billing for services not medically necessary (such as unnecessary hospitalization, surgery, tests, and equipment)
Double billing for services provided
Upcoding (billing for a more highly reimbursed service or product than the one provided)
Unbundling (billing separately for groups of laboratory tests performed together in order to get a higher reimbursement)
Fraudulent cost reporting by institutional providers
Kickbacks in return for referring patients or influencing the provision of health care
Other types of health care fraud schemes include providing services by untrained personnel, failing to supervise unlicensed personnel, distributing unapproved devices or drugs, and creating phony health insurance companies or employee benefit plans.
Congress has specifically established health care fraud as a federal criminal offense with punishment of up to 10 years imprisonment in addition to significant financial penalties.
If you are a medical professional charged with Health Care Fraud in West Palm Beach, Miami, or Fort Lauderdale, you are not only looking at criminal penalties and jail time, but also the loss of your license and the end of a career. Ann Fitz knows how important it is to protect your interests, and she will defend health care fraud charges against you aggressively.