People frequently associate white-collar prosecution with financial careers. People who manage investment accounts or run companies can commit fraud or embezzle. Many of the most dramatic cases of fraud involve those trusted to manage others’ resources.
However, there are white-collar crimes that can occur in many different industries, including the medical sector. Health insurance fraud, including government insurance fraud, is a common white-collar crime that rarely receives media attention. Both professionals who provide medical care and the support professionals running their offices could end up implicated in fraudulent billing schemes.
Which billing practices could lead to fraud charges?
Several seemingly benign billing practices are actually violations of insurance contracts and the law. Unbundling is a perfect example. It might seem reasonable to bill separately for services often billed together at a discounted rate. Doing so can increase the revenue for a hospital or medical office.
Unfortunately, doing so is actually a form of fraud and a violation of the agreement with the insurance provider. Upcoding or charging for a more expensive service than the one provided is also a common form of fraud.
Submitting an insurance claim for a canceled or missed appointment could also lead to allegations of insurance fraud. A variety of different billing practices could lead to intense scrutiny of a company’s practices and the prosecution of certain employees.
What are the potential penalties?
Health care fraud charges often lead to federal prosecution, especially if the fraud involved Medicare or Medicaid. The specific charges the person faces and therefore the penalties possible depend on the scope of the fraud that occurred and their role in the scheme.
Frequently, those accused of insurance fraud in the medical sector could face felony prosecution. The penalties the courts might impose could include jail time and fines. Orders of restitution to repay insurance providers or government programs are also common.
People with federal criminal convictions on their records may become ineligible for professional licensing in the future. They may no longer be able to work in the medical sector even after they serve their sentence and pay restitution.
Responding assertively to allegations of white-collar criminal offenses, such as health insurance fraud, may help protect professionals from the worst consequences. Those concerned about an investigation or a recent indictment may need help planning an appropriate defense.