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Health care fraud is common in many medical practices. It can be medical insurance billing fraud, HMO fraud, Medicare fraud, or even health insurance fraud. It’s illegal, and being charged with this kind of crime in California means you’re facing serious consequences in the eyes of the law. You could be fined, sent to jail, and issued various penalties that can change the rest of your life. Healthcare one of the most profitable industries in the world, and that makes it a prime candidate for many different types of fraud.
Unfortunately, there are many reasons people commit health care fraud. One of the most common reasons is financial gain. However, many people simply don’t realize they’re committing health care fraud or are the victims of health care fraud. Healthcare payments are complex and confusing, and it’s easy to make mistakes or make up small issues that can cause more billing than is really necessary.
What is Healthcare Fraud?
Legally defined, it’s the act of committing fraud in the healthcare industry. However, it’s much easier to explain when examples are used to help consumers understand what it means and how it works. Health care fraud examples include the following:
– Billing for medical services not performed
– Billing for more expensive services a patient did not receive
– Submitting duplicated claims
Most people who are guilty of health care fraud are people who work in the medical facility. A doctor’s office might decide they want to make more money, so they start adding different procedures to their patient’s charts when they’re sure the patient isn’t going to be billed for it. They bank on the fact many people cannot understand what their health care claims forms say or what they mean, and they make sure you don’t know what you’re being tested for in the office so you don’t suspect too much when you see your insurance paperwork come through every month.
Penalties for Health Care Fraud
California Penal Code 550 (a) PC does not allow health care or billing fraud in the state. If you are guilty of defrauding anyone in the healthcare industry for less than $950, you are guilty of committing a misdemeanor crime. This means you’re facing charges that include penalties up to six months in a county jail as well as fines of up to $1,000.
If you are charged with a felony, it’s because the amount of the fraud you’re guilty of exceeds $950. However, it does become a little bit more complicated here. This crime is a wobbler in California. This means the prosecution has the power to petition the court to allow them to charge you with a felony or with a misdemeanor. If you are charged with a felony, you face up to $50,000 in fines as well as two, three, or five years in a county jail.
Defense Against Health Care Fraud
There are two very common forms of defense in a situation like this. The first is lack of intent. You might have done something illegal, but you didn’t do it on purpose or with the intent of defrauding the healthcare industry. For example, if you work in a doctor’s office, you might have submitted a stack of medical bill claims to various insurance industries one day without realizing another co-worker already submitted the same claims.
The other most common defense is you simply didn’t know. You made a mistake because of your lack of knowledge. Perhaps you mistakenly entered the wrong code for a major surgery on a healthcare form. You said a patient underwent a surgery that costs hundreds of thousands of dollars when they only had a minor surgery. You mistakenly did this because you didn’t know you had to do it a certain way for it to work correctly.
Accidents happen, and it’s time for you to call an attorney to fight for you. You could spend years in jail if you are found guilty of a health care fraud offense. Let your attorney do the work for you while you prove your innocence. The healthcare industry is so complex, and it’s not uncommon for someone to make a billing mistake when they’re new to it, in a hurry, or even distracted.