In its most basic form, health care fraud consists of (1) billing for services that were not actually provided; (2) billing for a particular service when a different service was provided; or (3) knowingly misrepresenting that a claim is eligible for reimbursement under a government health care program or private insurance.
.. In an effort to fight health care fraud, federal and state governments have created a number of aggressive programs to identify illegal practices. These include anonymous antifraud hotlines, restructured procedures for filing complaints, and special investigative units. Providers such as doctors, dentists, physical therapists, nurses, chiropractors, mental health care professionals, and health care administrators are all susceptible to allegations of health care fraud.
In addition to imprisonment, extensive fines, and restitution, a criminal conviction for health care fraud can have a detrimental impact on a provider’s ability to practice. State licensing authorities may suspend or revoke the provider’s license. Insurance networks, hospitals, or other healthcare organizations may de-credential the provider. Finally, the federal government may exclude the provider from participation in government health care programs. Excluded providers cannot receive payments from government health care programs such as Medicaid or Medicare and cannot be employed by or contract with any entity that receives payments from these programs.
A provider involved in a health care investigation or prosecution has many interests at stake. Berry Law can help you protect these interests.