Healthcare Fraud

Healthcare fraud is a type of white-collar crime that involves the filing of dishonest health care claims in order to turn a profit. Fraudulent health care schemes come in many forms.

Examples of practitioner schemes include:

  1. individuals obtaining subsidized or fully-covered prescription pills that are actually unneeded and then selling them on the black market for a profit;
  2. billing by practitioners for care that they never rendered;
  3. filing duplicate claims for the same service rendered;
  4. altering the dates, description of services, or identities of members or providers;
  5. billing for a non-covered service as a covered service;
  6. modifying medical records;
  7. intentional incorrect reporting of diagnoses or procedures to maximize payment;
  8. use of unlicensed staff;
  9. accepting or giving kickbacks for member referrals;
  10. waiving member co-pays;
  11. prescribing additional or unnecessary treatment.

People can commit health care fraud by providing false information when applying for programs or services, forging or selling prescription drugs, using transportation benefits for non-medical related purposes, and loaning or using another’s insurance card.

When a health care fraud is committed, the health care provider passes the costs along to its customers. Because of the pervasiveness of health care fraud, statistics now show that 10 cents of every dollar spent on health care goes toward paying for fraudulent health care claims.

 

Healthcare Fraud – The Stark Law

The Stark law prohibits physicians from referring patients to receive “designated health services” payable by Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship, unless an exception applies. Financial relationships include both ownership/investment interests and compensation arrangements. For example, if you invest in an imaging center, the Stark law requires the resulting financial relationship to fit within an exception or you may not refer patients to the facility and the entity may not bill for the referred imaging services.

 

Contact Brian Zeiger

When you need a Philadelphia, Pennsylvania attorney to defend you when arrested and charged with a with a white-collar crime, contact Brian Zeiger. It is critical to have an experienced attorney advocating on your behalf. Brian Zeiger is an experienced criminal defense attorney who will vigorously defend your rights.

An experienced criminal defense attorney can help you determine whether you have any grounds for dismissal of the charges, explore plea options, or represent you at trial. Only someone familiar with the criminal court system and cases like yours will know how good your chances are for a favorable outcome. A knowledgeable attorney will take all of this into consideration, assist you in making decisions about your case, and protect your rights.

Contact The Zeiger Firm today at (215) 546-0340 for a consultation, and let us help you.

 

Sources:

  1. https://www.law.cornell.edu/wex/white-collar_crime
  2. http://corporate.findlaw.com/law-library/the-many-faces-of-health-care-fraud.html
  3. https://www.law.cornell.edu/wex/healthcare_fraud
  4. http://www.cigna.com/reportfraud/
  5. http://criminal.findlaw.com/criminal-charges/white-collar-crime.html
  6. http://www.nolo.com/dictionary/white-collar-crime-term.html
  7. https://www.law.cornell.edu/uscode/text/42/1395nn
  8. http://www.criminaldefenselawyer.com/crime-penalties/federal/Healthcare-Fraud.htm