As a medical provider, you want what’s best for your patients. You never want to file claims for services they don’t receive. Not only would it be unethical, but it’s illegal. You believe that your patients should only pay for the services you provide. Sometimes, you’re kind and don’t even charge them for minor things, like a sudden, quick office appointment, especially if they’re hurting for money. You’re an upstanding medical professional.
Despite the fact that you wouldn’t knowingly file a fraudulent claim, you’ve been accused of doing so. Several patients have claimed you charged them for services you didn’t actually provide. You don’t know how it happened, but you believe there’s an error in the books somewhere due to a computer malfunction or a new hire’s mistakes.
What is health care fraud?
Health care fraud is a white-collar crime. It is when a person files a dishonest claim with an insurance company or individual to seek a profit. Some common kinds of schemes include billing for care that was never provided, obtaining subsidized or free medications, and selling them on the black market, modifying medical records, forging prescriptions and providing false information when applying for services or programs to help patients.
Since fraud comes in many different forms, it’s important for you to understand what, exactly, you’re being accused of. Sometimes, allegations erupt because of a misunderstanding, so it’s a good idea to review documents with your patients if they’re confused about how they were billed. You can also speak directly with an insurance company if it believes that there was fraud taking place. You can show which services you performed and how you coded those services when you sought payment.
What happens when you file a claim with insurance?
There are laws that require legitimate claims to be paid within 30 days of notifying the health care insurance provider. The negative thing about this is that it’s more likely for insurance carriers to pay before any kind of investigation begins. As a result, you may find yourself facing accusations for something you didn’t do long after you received payment.
What happens if you’re convicted of health care fraud?
A conviction leads to many problems for doctors and other health care providers. Successful prosecution may lead to fees and fines, incarceration or other charges. Some medical providers may lose their licenses if they’re found guilty of fraud.
It’s important for any medical doctor or provider who faces allegations of fraud to quickly turn to an attorney for support. Allegations of fraud put your very career at risk, and that’s not something you want to lose. If an allegation turns into charges and a conviction, you could find yourself in a difficult position that is hard to reverse.