Working in the healthcare industry can be a great source of income and job stability, but it can also create legal risks, particularly when a practice tries to optimize its profits through questionable billing practices. Whether you work in patient care or as a billing specialist, if the hospital or medical practice where you work faces allegations of healthcare fraud, you can easily wind up as one of the people facing federal charges as a result.
Unlike many other kinds of white-collar crime, serious health care fraud often gets investigated by federal authorities and prosecuted by the United States government, not necessarily the state where the offense took place. It can also result in civil liability or lawsuits against a practice or provider.
Fraudulent billing involving government insurance is a federal offense
There are layers to the law. You are likely subject to the rules set in place in the city or municipality where you live or work, as well as state laws in Missouri. Additionally, federal regulations often apply to those in the healthcare industry.
There are many rules regarding how medical professionals and practices must document their work and bill for the services rendered. Those seeking to manipulate those rules for profit could violate federal law by doing so.
For example, billing for a more expensive procedure than the one performed or intentionally unbundling services typically billed at a discounted rate could result in healthcare fraud allegations. Even if you never profited from the fraud or played a minimal role in what happened that led to charges, you could wind up swept up by federal enforcement efforts.