In the United States today, billions of dollars are lost to healthcare fraud, which assumes a number of forms: Medicaid fraud, Medicare fraud, Tricare fraud and more.

The advent of the Affordable Care Act has increased the number of billings and, consequently, created more opportunities for fraudulent transactions. So much money is being stolen that any unusual billing activities are being prosecuted as fraud even when the healthcare professional or patient in question made a genuine mistake.

How healthcare fraud works

Healthcare fraud is a criminal charge that usually arises after a person or entity appears to be claiming reimbursement for medical products and services that were never provided or performed. Common defendants include hospitals, medical clinics, dental offices, nursing homes, and drug and alcohol treatment centers. Examples of fraud committed by these healthcare providers include:

Billing for services and tests that were never actually performed, a process known as phantom billing

• Upcoding, or billing for a more expensive procedure than the one actually completed
• Unbundling, or billing each stage of a medical procedure as if it were a separate service
• Falsifying a diagnosis to justify unnecessary medical procedures
• Misrepresenting a procedure in order to be reimbursed for services not normally covered by health insurance
• Soliciting and accepting kickbacks for referring patients
• Fraudulently filling or refilling prescriptions
• Committing health insurance fraud in connection with no-fault insurance

Individual consumers can commit healthcare fraud using methods like the following:

• Forging or altering receipts and bills for medical services
• Submitting claims for services or medications they never actually received
• Using someone else’s insurance card and/or coverage

While some people deliberately attempt to defraud the system, others find it so difficult to keep up with the constantly changing rules that apply to Medicare, Medicaid and other insurance programs that they make mistakes.

Allegations of healthcare fraud can create serious consequences for the medical professionals and organizations accused. Unless the charges are dropped or successfully defended, potential outcomes include jail time, heavy fines, and loss of business or medical licenses. Consumers accused of playing the system will, if found guilty, be left with a criminal record that limits their job opportunities and access to certain professional licenses.

If you or your institution/facility have been accused of healthcare fraud, then retain an experienced New York criminal defense attorney immediately. Facing such a serious charge without expert legal advice would be a mistake. After reviewing your case, your attorney will develop a strong and thorough defense and work to avert the charges, get them reduced or, if the matter goes to trial, obtain a full acquittal in court. When your freedom and future are at stake, you deserve the best fighting chance. The Law Offices of Julie Rendelman, LLC offers clients who have been accused of healthcare fraud this very chance. Call 212-951-1232 to arrange a free consultation with Ms. Rendelman.