When the media talks about Medicaid and Medicare fraud, they almost always focus on individuals receiving benefits they don’t necessarily deserve. However, fraud perpetrated by medical professionals costs the government the most money. Doctors and other medical providers can abuse their position of trust and authority to intentionally overbill the government for services rendered.
Regardless of the way in which they do so, if caught, these professionals and other members of their staff could face serious criminal charges. Working as a medical billing professional puts you at risk of fraud allegations or charges, even if you aren’t directly responsible for it. Handling the billing process often implicates these professionals, even if they don’t receive any kind of compensation related to the fraud.
If your employer engages in fraudulent billing practices, it is your obligation as a citizen to report that abuse. Failing to report suspected Medicaid or Medicare billing fraud could mean that, in the future, you become implicated in fraud or even conspiracy charges related to the manner in which your employer billed the government for services rendered.
Federal health care fraud can take many forms
There are countless ways in which a medical professional could, theoretically, abuse and improperly bill government insurance programs. The most straightforward and obvious is the practice of charging for services not rendered.
A medical professional may use codes similar to the procedure performed. That way, the patient won’t notice if they look at their bill. However, there could be a significant price discrepancy between two similar-sounding procedures. In some cases, doctors will bill for appointments that never even occurred.
Another common practice is called unbundling. Insurance companies negotiate discounted rates for certain services commonly performed at the same time. It may be significantly more money to charge for each individual service. Doctors may intentionally and knowingly unbundle services they provide and charge for them individually in order to maximize how much they bill.
These are only two common examples of ways that medical professionals can engage in billing fraud. There are many other forms that fraud can take as well.
You are legally bound to report suspected fraud
You don’t have to be directly informed that the doctor you work with is doing something fraudulent with billing. Instead, you only need to have been reasonably aware of improper practices. If there is any potential that a prosecutor could prove you knew what was happening, you could wind up convicted, even if you never financially benefit.
There are anonymous systems through which you can report your employer for suspected fraud. You also receive protections as a whistleblower. If you or your employer are already facing criminal charges related to billing fraud, you want to speak with an experienced criminal defense attorney as soon as possible about your situation.