A New York Fraud Defense Lawyer Explains Health Insurance Fraud
The federal government provides insurance to many individuals in the form of Medicaid or Medicare. Private insurance companies also pay for healthcare services. Fraud against a private health insurer or government health insurer is considered a serious crime. You may face prosecution under federal or state laws if you are accused of defrauding a health insurer.
At Bukh Law Firm, PLLC, our experienced attorneys have represented individuals, hospitals, health clinics, doctors, pharmaceutical salesmen, nurses, and other medical professionals who are accused of involvement with health insurance fraud. Our attorneys have experience with the complex rules applicable to insurance billing and health fraud crimes and we understand how to help clients make compelling cases to try to avoid conviction. Don’t let your assets be seized, your career ended, and your freedom be taken without a fight call today to get help if you are accused of health insurance fraud.
What is Health Insurance Fraud?
Health insurance fraud can be broadly defined as engaging in any scheme to obtain money or property from a private or government health insurer. Anyone involved in any part of the scheme can be charged with the fraud offenses not only that he committed but also any offenses committed by co-conspirators.
Both state and federal laws criminalize health insurance fraud, so you can be charged in state or federal court. You could also face a civil action to try to recover funds obtained through the fraud scheme. You need to be prepared to fight on all legal fronts. Bukh Law Firm, PLLC has experience with state and federal criminal cases, regulatory actions, and civil claims.
Types of Health Insurance Fraud
Health insurance fraud can take different forms including:
- Medical identity theft: An individual uses someone else’s identity to obtain medical services under that person’s insurance.
- Upcoding: A health care provider bills for a higher level of services than is provided.
- Unbundling: A service that is bundled and should be billed under one insurance code is instead broken down and each separate part of the service is billed under an individual code to generate more payments.
- Billing for unnecessary medical treatment : A health provider bills for services that are not needed. When these services are performed, the insurer loses money and the patient undergoes procedures that are not medically necessary.
- Billing for services or items not provided: A provider bills for services not performed or supplies not provided.
- Kickbacks: A provider offers to exchange, or actually exchanges, money or items of value in return for referrals.
Providers and patients may both be accused of involvement in health insurance fraud scams. Bukh Law Firm, PLLC represents anyone within the medical industry as well as patients accused of participating in a scam to defraud an insurer.
Health Insurance Fraud Penalties
Health insurance fraud penalties differ depending upon whether you are charged on the state or federal level. There are both civil and criminal consequences. For example:
- 18 U.S.C. Section 1347 imposes up to 10 years imprisonment for participating in a scheme to defraud a health insurance provider and improperly obtain money or assets from the provider.
- 18 U.S.C. Section 1035 imposes a penalty of up to five years imprisonment for making false statements in connection with the delivery of healthcare services.
- 42 U.S. Code Section 1320a-7a imposes a civil fine of up to $10,000 per instance of improperly making a claim for payment of health services.
- 42 U.S. Code Section 1320a-7B imposes a maximum penalty of five years imprisonment for making false statements or misrepresentations in an application for payments or benefits under a federal healthcare program.
These are just a few possible consequences that may be associated with a conviction for health care fraud. If you are under investigation or have been arrested, you don’t have to be convicted- you can try to fight the charges or negotiate a plea deal. Let Bukh Law Firm, PLLC help you decide on the right course of action.
How Can a Health Insurance Fraud Lawyer Help
A prosecutor has to prove fraud occurred for you to be found guilty of a crime. Health care billing is complicated and it is entirely possible that innocent mistakes or even legitimate transactions could appear to be fraudulent even when they are not.
You need to vigorously defend yourself against any accusations of health insurance fraud. Call Bukh Law Firm, PLLC today to get an experienced fraud defense lawyer on your side to help.
