Healthcare fraud is a very real concern in our nation and is a heavily investigated crime, as it should be. However, during the tenacity of these investigations, the truth is sometimes overlooked and the innocent are sometimes wrongfully accused. The Los Angeles federal criminal defense lawyers at LibertyBell Law work hard to ensure the best defense for our clients.
Law enforcement is cracking down on suspected healthcare fraud committed by doctors, lawyers, and any other suspected individuals. This includes patients that willingly participate in such acts.
As nationwide healthcare spending increase, so do inquiries into that spending. Over time, these inquiries have uncovered some illegal practices by dishonest healthcare providers. Due to these practices, investigative teams have been formed and grants have been acquired to uncover more.
What Exactly are Healthcare Fraud and Illegal Kickbacks?
Healthcare fraud is, in short, when a provider charges patients or insurance companies incorrectly for the purpose of profit. A few examples of the actions that have been uncovered include the following:
- Some providers charge for more expensive services than the patient actually received.
- Some procedures require multiple steps to complete. These steps are supposed to bundle together and charged as one procedure. Some providers, however, make a practice of breaking the process down and charging for each individual step to increase profits.
- At times, some providers might send their patient a bill for a procedure or visit that insurance already covered.
- Billing non-covered services as services that insurance does cover is another version of fraud. For instance, if a patient goes in for elective plastic surgery, the majority of insurance companies will not pay. However, if the surgeon bills it as a medical necessity, such as fixing sinus issues or a deviated issue, insurance will more than likely pay for it.
- Another illegal practice is billing patients or insurance companies for services that never occurred. A patient would likely catch this fraud more quickly than an insurance company, though, so insurance companies are victims of this the most.
- Even having patients go through tests and surgeries they do not need for the sake of profit has been reported.
Receiving illegal kickbacks is what occurs when a healthcare provider receives a payout for referring a patient to a specialist or surgeon that they do not need to see. The surgeon or specialist then makes money from billing for non-rendered or unnecessary services.
The Effects of Health Care Fraud and Illegal Kickbacks
Healthcare fraud is a very serious matter, just as accepting illegal kickbacks is. These actions cost taxpayers, the government, and patients money and resources. It also has the propensity to affecting a patient’s health and safety. Some specific costs of these crimes are:
- Patients have to pay higher premiums and more out-of-pocket expenses. Often, these patients cannot afford these additional expenses. Therefore, they may not get the medical attention they need.
- On an even more serious note, sending patients for and performing unnecessary surgeries on patients can lead to illness, injury, and even death.
- The majority of insurance companies have a maximum amount of benefits that the insured can receive each year. When that limit is met, the patient is responsible for their own expenses. If someone bills for unnecessary charges and a patient’s insurance coverage cap off due to health care fraud, the coverage is not there when they need it.
- As insurance coverage decreases, the number of citizens applying for welfare increases. Those that have a difficult time currently paying for insurance will only have a more difficult time as they cannot pay for their care. It will be necessary for them to apply for assistance.
- As the nation’s spending on health care increases, investigations begin to determine why there is such an increase.
Due to the effects it has on the country as a whole, HIPAA declared healthcare fraud a federal crime, and it comes with some pretty stiff penalties. If one is found guilty, a participant can face both prison time and hefty fines that vary according to the severity of the offense.
- Healthcare fraud itself- with no extra charges – brings with it prison time up to 10 years as well as fines.
- If a patient is injured due to the fraud, such as by getting treatment they do not need or suffering for the treatment they could not receive, those punishments double.
- If a patient dies due to the fraudulent act, i.e. surgeries that were not required, the punishment is as much as life in prison.
With such serious consequences, it is no wonder that the government wants to eradicate the issue.
LibertyBell Law is On Your Side
If you stand accused of committing healthcare fraud or accepting illegal kickbacks in Los Angeles, California, it is important to take the matter seriously. You should prepare to obtain a federal criminal attorney Los Angeles as soon as you are made aware of an existing or building case.
LibertyBell Law has a strong team of attorneys that can help you through this process. We are experienced in major criminal cases and dedicated to defending our clients’ civil liberties. Protecting and representing you prior to and throughout your trial is our specialty.
Your reputation and freedom are in the balance. At such a serious time, the people you choose to stand beside you could mean the difference between freedom and imprisonment. You need an experienced Los Angeles criminal defense attorney to help you write the ending of your story.
Trial preparation is a vital step toward victory and should begin as soon as possible. We here at LibertyBell Law are ready, willing, and prepared to get you through this difficult time. Do not hesitate to give us a call so that we can begin building your defense immediately.
If you have any questions or concerns about healthcare fraud and illegal kickbacks or have experience with this issue, please comment below.