When the United States moves towards a health system that aims to benefit and is funded by private insurance firms, it is common for clinics, hospitals, and physicians to help. To make a profit, healthcare providers will surpass integrity and be dishonest, even against public programs, such as Medicare and Medicaid.This is an article contribution by Lawyer James S. Bell.
Health fraud happens if a healthcare provider tries to defraud the insurance system to obtain more income than they received. The patient may also commit health fraud if the patient provides the health insurance provider with inaccurate and deceptive details to get healthcare benefits.
Such fraudulent acts are a federal crime and can result in many criminal and civil consequences.
- Goods/services billing not given.
A common form of Medicaid or healthcare fraud scheme is billing never-rendered medication or procedure — for example, X-rays, medical tests, or never-exempt medications.
Fraudulent companies “upcode” specific medical procedures, as well. When a patient sees a doctor, the extent of services provided may not be known to the patient. The time can be extended if units make payments of time. A minor service may also be upgraded as a more work-intensive or expensive operation.
- In return for referring companies, charging “kickbacks.”
“Kickbacks” are common in cases of health fraud. In general, state and federal law prohibit payments to persons referring patients to a particular hospital or physician. For example, Medicaid fraud charges were launched against dishonest doctors for splitting rental fees, alleged Medicaid patients for cash, and taking money in return for patient referrals.
- Medically unnecessary testing billing.
Some providers misrepresent the diagnosis and symptoms of their medical reports and then give the insurance companies’ invoices to obtain a higher interest rate. One example would be a patient who visited the doctor for standard cold treatment. Still, a disease diagnosed as pneumonia was paid to the insurance provider, which required a pneumonia test.
- Paying excess medical expenses.
This is a scheme in which crooked nursing homes are most frequently involved. Care homes are reimbursed based on the annual expense estimate. It isn’t very ethical to include personal expenses at such cost reports. An example of this is the cost of a private car or home on a nursing home administrator’s cost report. This is a statutory violation.
- Inflating the supply of bills for services.
This is often the case in the transport sector for Medicaid, where van/taxi companies are massively inflating their reported miles to be reimbursed more.
- Managed care organizations (MCOs)
Managed care poses multiple issues with fraud. While the scam is characterized by overcharging in standard healthcare reimbursements, a controlled care environment creates an incentive to refuse patients/contractors. While the MCO pays a fee to the physician for covered services, the services are denied or reduced for other than sound medical reasons. Not only does this disappoint the insurance company, but it also compromises the health of patients.
MCO fraud also happens in registry practice, in which healthy patients are “recruited” to join other MCO’s in a process known as “cherry-picking.”
- Double billing
Double billing takes place when the retailer receives payment from two outlets. For example, an insurance company is paid by a drug study provider when obtaining a pharmaceutical company’s debt. Similarly, the same policy may be paid for two insurers or public services, or both.
The role of a healthcare fraud attorney is integral because different healthcare providers face these problems. The court can result in criminal charges, expulsion, cancelation of licenses, and high compensation. It is also imperative to employ a trained healthcare professional when accused of subsequent commands.
Since government agencies are interested in the investigation and prosecution of these cases, the recruitment of an experienced healthcare professional may be a smart option. With ample expertise in handling these cases, a trained health care fraud lawyer with experiences of pharmacy fraud, medicare fraud or prescription fraud cases may resolve all allegations.
Instead of going through the whole litigation process on your own, hiring an experienced lawyer will make a significant difference between success and failure. An attorney will more efficiently represent the case before the jury. The following are the main advantages of employing a health care fraud lawyer.
- Case compilation with efficiency
One of the key benefits of hiring a skilled healthcare professional was his ability to present all the facts and figures well coordinated. A lawyer who works with you must analyze all facets of the case to create a successful argument with you.
- Experienced evidence attainment
In cases of medical neglect, the facts of the case are nuanced and multifaceted. Therefore, you need ample witnesses to support your argument. A qualified lawyer has an intimate knowledge of the mechanism by which the claims are confirmed.
Article Contributor Information
With over fifteen years of experience, James S. Bell P.C. has forged a name as a leading United States trial attorney. Most notably, Bell obtained the largest verdict in the United States in 2017 and the ninth (9th) largest verdict in United States history against JPMorgan Chase Bank for in excess of $6,000,000,000 (6 Billion Dollars).
Bell has become a recognized legal thought leader through projects such as co-authoring an article titled “Piercing the Corporate Veil” regarding property division in divorce and features in publications such as Forbes, Inc., and Entrepreneur and has been granted recognitions such as Best Personal Injury Attorney and Litigator of the Week.