To many people, health care fraud seems like a victimless crime. Many medical practices operate on a narrow margin, meaning they need to produce as much revenue as possible. Insurance contracts often limit what a medical provider can charge for their services, which may prompt them or their billing support staff to get creative in their approach to billing.
Whether a medical billing specialist double-bills for appointments or overcharges, as long as they don’t bill the patients for those fraudulent charges, they probably won’t think that little acts of fraud are actually crimes. They may think that because they don’t personally take the money, they can’t face criminal charges.
However, taking liberties when billing insurance, both private insurance policies and state insurance like Medicaid or Medicare, can easily lead to criminal charges. In fact, such behavior will very often result in federal criminal charges.
Health care insurance fraud impacts the government or interstate commerce
There are both federal and state laws that apply to health care and insurance billing practices. However, many people charged with insurance-related fraud offenses will find themselves facing federal charges.
Insurance companies often service multiple states, blurring the lines of jurisdiction in an insurance fraud situation. The fraud could, therefore, impact interstate financial transactions. In cases where the fraudulent billing makes claims against Medicare or Medicaid, the government, and therefore the taxpayers, are ultimately the ones victimized by that fraud.
The sad truth is that even those who have not directly financially benefited from insurance fraud can still face charges. Understanding the white collar criminal allegations against you may be the first step toward defending yourself.