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Healthcare fraud: What causes the government to file charges?

Healthcare fraud occurs when the government makes an accusation that someone filed false healthcare claims for financial gain. The government can accuse medical professionals throughout the healthcare field of a violation. Examples include:

  • Physicians. Billing for medical care or services patients never received, performing unnecessary procedures, filing duplicate claims or incorrectly reporting the claim to one that receives a higher payment.
  • Hospitals. The government can accuse medical facilities of inflating costs for inpatient care.
  • Medical equipment suppliers. Billing for equipment that was never delivered or overcharging for medical devices.

The government uses two main techniques to build a claim. The first is the use of whistleblowers within the organization notifying the government of a potential violation using the Federal Claims Act (FCA). The second is the use of technology to aid in finding potential violators. This includes the use of data mining to help gather evidence to build a case.

What happens if you are accused of healthcare fraud? Medical practitioners generally become aware of an investigation in one of two ways. Either they get a letter from their Medicare carrier or federal agency or they have someone come to their door with a search warrant.

In either case, it is important to fight the allegations. Gather documents to support claims made for payment. Avoid taking a plea deal before discussing the possible repercussions with an attorney. The deal could result in the loss of your medical license and, ultimately, your profession.

You can successfully fight these allegations. Contact an attorney to discuss your options.