Health Care Fraud: A Serious Legal Charge

by | Feb 28, 2013 | Law

Health care is one of the most hotly discussed issues in the country today. With the massive changes in the industry as mandated by the Health Care Overhaul, the controversy stirred up by the HHS Mandate, and the rising costs of health care, you would be hard pressed to find someone without a strong opinion on the issue. Perhaps because of this, health care fraud is a more serious charge than ever before, requiring the services of an experienced and highly ethical Sacramento criminal defense attorney. There are several types of health care fraud, but all of them involve cheating an insurer or government agency out of funds. It is a serious problem, and the FBI reports that health care fraud costs US taxpayers an estimated $80 billion dollars a year. Because, whistleblowers (i.e. those who report health care fraud) are rewarded, these individuals were paid a total of $307,620,401 in 2010.

Most health care fraud involves false claims or manipulated claims to Medicare. One type of health care fraud charge that would require the services of a Sacramento criminal defense attorney is billing for services not rendered. This usually means that an individual or doctor reports procedures or services to Medicare that were never actually performed. A similar charge is filing the same claim twice; usually an individual will make a small change to the service, such as the date it was performed and thus make one legitimate claim and one repeat claim. Two other charges are upcoding of services and items. Upcoding of services means that a doctor reports a more expensive procedure to Medicare than the one that was actually done. Upcoding of items is similar, but instead a doctor reports more expensive equipment than was actually used. For example, a claim may be made for an electric wheelchair, when the patient only received a manual one. A similar charge is a claim for excessive services. For example, a doctor may perform more procedures or more expensive procedures than are actually necessary. Unbundling is another type of fraud in which a doctor or individual breaks up the claim and submits it to Medicare or an insurance company in small chunks. Filing in this fashion usually costs the insurance companies more than one large claim. A final type of health care fraud charge requiring the services of a Sacramento criminal defense attorney is a kickback charge. In these cases, a doctor receives money or an expensive gift in exchange for proving a more expensive treatment than necessary. Persons charged with this crime are also subject to the regulations of the federal Anti-Kickback Statute.

Because health care fraud is such an expensive crime for the American populace, and because health care has become such a hot button issue, these fraud charges have become more serious than ever before. If you or someone you know has been charged with health care fraud, it is of the utmost importance to hire the most experienced and dedicated Sacramento criminal defense attorney for your trial.

Those looking for a top Sacramento criminal defense attorney will find one at Kimball & Wilson, LLP. For more information, visit them online!

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