Common Types of Healthcare Fraud

You may be surprised to learn about how many types of healthcare fraud there are, as well as how often these offenses occur.

Who Investigates Healthcare Fraud?

The FBI is the main agency that investigates reports of healthcare fraud. They work with state and local agencies, insurance companies, and other anti-fraud groups.

Healthcare fraud is a white-collar crime that can result in federal charges. Individuals guilty of healthcare fraud may also face civil charges, depending on the circumstances of the offense.

Fraud Committed by Medical Providers

Physicians have been arrested and charged for numerous types of healthcare fraud.
Some of these offenses include:

• Double billing: submitting multiple claims for the same service
• Unnecessary treatments: giving unnecessary treatments or tests to patients
• Upcoding: billing patients for more expensive services they did not receive.
• Waiving payment: waiving deductibles or co-pays

There are numerous other examples of ways that healthcare providers inaccurately report and use services to benefit financially.

When a healthcare provider is found guilty of committing fraud, they risk losing their license to practice medicine.

Fraud Committed by Patients

Patients can also commit healthcare fraud.

• Identity theft: using someone else’s health insurance or allowing someone else to use your health insurance benefits.
• Impersonating a healthcare professional: providing healthcare services without a valid license to practice.
• Faking illness: falsely reporting symptoms in order to get a prescription

Prescription Fraud

Many instances of healthcare fraud are related to prescription medication. Some patients may engage in ‘doctor shopping.’ This occurs when an individual visits multiple doctors in order to get multiples of the same prescription. This may be due to the patient’s underlying substance abuse issues or for more nefarious reasons, like drug trafficking.

Fresno Fraud Attorneys

If you are facing federal fraud charges, contact Schweitzer & Davidian. We have helped numerous individuals in similar positions, and have invaluable experience going up against some of the toughest federal prosecutors in the nation. You can trust us with your case.