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What is health care fraud?

When you think about fraud, you may consider credit card fraud before health care fraud comes to mind. However, incidents of healthcare fraud do occur in New York. It is important for you to understand what this can look like.

Health care fraud can come in a variety of forms. The National Health Care Anti-Fraud Association says that you have committed fraud if you gave a patient a false diagnosis so unnecessary tests could be performed or conducted a procedure which was not medically necessary. Receiving payment when a patient refers someone to your practice or saying a procedure is covered under a patient's health care when it is not are other forms of fraud. Additionally, you commit fraud when you charge patients for procedures that were not performed.

Medical identity theft is another form of health care fraud. This entails using a person's medical record to create new records or add information to a person's current record. Additionally, this form of fraud sometimes uses all of a person's health benefits. Health care fraud can be a serious offense because many insurance companies may receive these false billings and information.

Committing health care fraud is considered a federal criminal offense and can have serious consequences. You may be imprisoned for 20 years if a person was harmed, and the act of committing fraud, regardless of whether a patient was harmed, can result in a 10 year prison sentence. You may sometimes receive life in prison if a patient died because of health care fraud. You may also face financial penalties.

This information is general in nature and should not be used in place of legal advice.

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