What to do if accused of health care fraud as a physician

On Behalf of | Dec 18, 2020 | Federal Crimes |

It can come as a shock to find yourself accused of health care fraud. When you run a busy medical practice, you may have several people that help you. You probably do not check their every move. Yet, they may be committing fraud under your nose without you knowing.

What is health care fraud?

Fraud is when someone deliberately does something dishonest to benefit themselves or another party. When it is related to medical services, it is known as health care fraud.

What are some examples of health care fraud?

  • Defrauding patients: Many health care frauds are related to the billing process. Your secretary could be overcharging a patient without your knowledge. They could bill them for services they did not receive, increase the pricing for items or services, or persuade a patient to undertake unnecessary examinations.
  • Working with a patient to defraud the insurer: Your secretary could have worked together with a patient to defraud the insurance company. They could agree to issue receipts for services that were not given or needed or inflate the bill’s value.

Medical coding errors can lead to fraud accusations

Your staff may use medical codes for entering billing information. An inexperienced staff member may make a mistake. They may not realize that specific services should be bundled together under one code and bill them separately. Or they may be tired and input the wrong thing.

As a medical practitioner, it is better to spend your time treating patients, not doing paperwork. Yet, when investigators trace a health care fraud to your practice, you might be in the line of fire. You will need legal help to show that you were not involved and protect your reputation.


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