Healthcare fraud is a serious problem in America, which has been estimated to cost taxpayers at least $60 billion a year. All participants in the medical industry can be charged with fraud, including individual patients, doctors, pharmacists and nurses or entire hospitals, physician’s offices, pharmacies and urgent care clinics. Unfortunately, some of these cases come down to innocent mistakes or misunderstandings. If you or your company has been accused of this serious crime, please call a top Vista health care fraud defense attorney as soon as possible.
Healthcare Fraud by Providers
Doctors, hospitals, pharmacies and all other participants in the medical field can be charged with fraud in California. The most common form of fraud by providers includes billing insurance companies or government programs such as Medicaid (known as Medi-Cal in California) or Medicare for services that were not actually rendered. Sometimes the bill will include procedures, tests or drugs that were not used on a patient.
In other cases though, services or medications provided to patients may actually be unnecessary and only given for the purposes of inflating the bill. Another form of fraud involves providing patients with generic drugs and charging for more expensive brand name drugs, although this type of crime is less common than billing for unnecessary or unperformed services or medications.
The most common victims in these types of schemes are private insurance companies or the state or federal government if the bill went to the Veteran’s Administration, Medi-Cal or Medicaid, though in some cases, uninsured patients may end up footing the bill. Because fraud costs insurance and government agencies so much, each of these institutions has their own fraud investigation units to uncover suspicious billing and evidence against entities suspected of fraudulent billing. This is why it is so important to always work with an attorney with experience helping clients in need of a strong defense against charges of health insurance, Medicare and Medicaid fraud.
When a Patient Commits Fraud
While the great majority of health care fraud expenses come from fraudulent activities committed by healthcare providers, patients can also be charged with this crime, there are many ways patients can scam the medical system, including when someone participates in a “doctor shopping” scam to obtain large quantities of prescription narcotics. In rare cases, a patient may pretend to have a condition that requires him or her to get expensive medical equipment, which she may then go on to sell to a third party.
When it comes to prescription drug crimes, one of the most common methods is the forging of a doctor’s signature on a prescription pad to obtain pain medication. People often get addicted and know their doctor won’t over-prescribe controlled substances so they forge their doctor’s signature to get more drugs.
One of the most common forms of fraud committed by patients is the act of using someone else’s identity in order to obtain medical services for someone who is uninsured or underinsured. While this specific motivation may be to help someone in serious need of medical services who can’t otherwise afford them, this is still a criminal act and even if you were trying to do a kind act, attempting to use this as a defense will only be used as evidence of your guilt, which is why it’s so important to speak with a health care fraud lawyer if you have been accused of this crime.
Penalties Vary Greatly
The penalties for health care fraud, including all forms of Medicare and Medi-Cal fraud, vary greatly based on what specifically occurred, which is why it is always advisable to speak with your defense lawyer regarding the specific penalties you could end up facing. Fraud cases involving large quantities of money or that may have resulted in someone being hurt through the reckless performance of unnecessary medical services or prescriptions will carry much more serious sentences. Those responsible will generally be forced to pay back those they defrauded as well.
It also depends on who is being charged. An organization cannot face prison or jail sentences, but will face massive monetary penalties and lose its ability to to participate in federal and state healthcare programs. Individuals can be incarcerated and doctors, nurses and pharmacists may lose their professional licenses so they can no longer work in the medical or pharmaceutical industry.
If you have any questions about these charges or believe you may be under investigation, please call top Medicaid and Medicare fraud criminal defense attorney Peter M. Liss. Those in North County can schedule an free consultation at his Vista office by calling (760) 643-4050, while those in San Diego can arrange an appointment at his Carmel Valley office by calling (858) 486-3024.
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