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Factors that could lead to healthcare fraud allegations

On Behalf of | Mar 4, 2024 | Professional Licensing Defense

Doctors spent years developing their knowledge and expertise in the medical field. They have built their reputation around the trust of their patients. All this work could go down the drain if they get involved in healthcare fraud accusations. No one wants to get involved in any allegations that could damage their professional status. But sometimes, mistakes can happen due to the complexity of the healthcare system. It is crucial for doctors and medical professionals to know about instances of healthcare fraud and avoid them as much as possible.

What is healthcare fraud?

People hold licensed professionals like doctors to a high standard due to the specificity of their job. Thus, policies are strictly enforced on them, and mistakes are investigated thoroughly. Sometimes, it can only take one mistake to revoke a license.

One of the most common reasons for revoking a license is through healthcare fraud. Healthcare fraud is billing unnecessary, unperformed or overpriced services, drugs or supplies to the patient or their insurance. This causes billions of dollars in losses each year, which can ultimately lead to increased health insurance premiums and taxes.

Common types of healthcare fraud

Individuals and businesses could be involved in healthcare fraud. These are the common types of healthcare fraud that are applicable for doctors and medical providers:

  • Phantom billing: This is when a medical provider charges for services that were never performed or supplies that were not used for the patient.
  • Double billing and unbundling: This refers to submitting double or multiple claims and bills for the same service.
  • Upcoding: This means billing for a more expensive service than the actual service the patient received.

Dishonest medical billing constitutes as a crime in California. Doctors proven to engage in billing fraud could be imprisoned for up to five years. They could also be fined up to $50,000, or even greater depending on the amount of fraud.

Facing an allegation of healthcare fraud is stressful and devastating, not just because of the possible penalties imposed on you, but also because of the risk of having your professional license revoked. If you are facing charges of healthcare fraud or if you feel like you will be investigated for it in the future, immediately seek the assistance of an experienced lawyer who can help you with potential defenses.