Can I Be Prosecuted for Healthcare Fraud if it Was a Billing Mistake?
Healthcare fraud occurs when a person provides false or misleading information to get an insurance company to pay for services that were not rendered or to receive unearned benefits. Although healthcare fraud can be committed by recipients or providers, a provider found guilty of fraud typically faces harsher penalties under the law.
If you have been accused of a fraudulent claim or deceptive billing practice, you likely feel terrified. Healthcare fraud can be prosecuted at the state or federal level, with federal charges often being investigated by the FBI in collaboration with other government agencies. While state charges will be investigated by the state Attorney General, federal charges will be investigated by several federal agencies. The moment you find out about these allegations is the moment you should contact the Greenville insurance fraud lawyers at Ryan Beasley Law.
Types of Healthcare Fraud Committed by Providers
The vast majority of provider fraud involves providing misleading or false information with the intent to deceive the healthcare system, with dishonest practitioners often resorting to the following:
- Billing for unnecessary medical services
- Billing for services not rendered
- Billing multiple codes for a group of procedures that would be covered in a single global billing code, known as unbundling
- Knowingly treating someone other than the individual insured and seeking reimbursement for such services, known as card sharing
- Billing for more complex services than were actually provided, known as upcoding
- Offering another medical provider or supplier a cash, gift, or other financial incentive to refer patients to their office, known as a kickback
Can I Be Charged with Healthcare Fraud if it Was an Honest Mistake?
While many providers commit healthcare fraud intentionally, a negligent misrepresentation can still be considered healthcare fraud. That is why it is so important for providers to check billing codes before submitting information to insurance. Even if you inadvertently committed the error, you are not immune to the law.
If your error involved a federal government program such as Medicare, then you will be tried in federal court. Alternatively, if you are accused of Medicaid fraud, you could be prosecuted under state or federal laws. Since Medicaid is jointly funded by the state and federal government, a larger scheme will likely result in federal charges. Since most states, including South Carolina, have developed Medicaid fraud units, you may be facing state charges under certain circumstances, such as an isolated event or if a vulnerable adult is involved.
Tenacious Representation Fighting for You
Legislation does not go lightly on healthcare professionals who make an error on a submitted claim. While your mistake may have been unintentional, it is often difficult, if not impossible, to prove that. Even state charges impose harsh penalties, with a conviction potentially resulting in three years in prison and a $1,000 fine. Additionally, the Attorney General may fine you up to three times the amount of overpayment for each claim, with the court imposing a $2,000 fine for each false statement.
Given the severity of a healthcare fraud charge, it is crucial that you speak with the Greenville insurance fraud legal team at Ryan Beasley Law. By contacting us the moment you are made aware of a pending investigation, we can help to build a strong defense to mitigate any legal consequences. Our insurance fraud attorneys have helped hundreds of providers avoid jail time and pay minimal amounts in fines and restitution.
Speak with Our Greenville Insurance Fraud Attorneys Today
If you are facing accusations of providing false or misleading information when submitting an insurance claim, our Greenville insurance fraud attorneys are available to assist you. For nearly 25 years, the legal team at Ryan Beasley Law has defended the rights of individuals such as yourself against criminal charges, helping them maintain their civil liberties. To learn more about our services or to schedule your consultation, contact us online or by phone at (864) 756-4204 today.