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Matthew Radefeld & Dan Juengel
Matthew A. Radefeld and Daniel A. Juengel

What you need to know about healthcare fraud, a white-collar crime

On Behalf of | Jun 21, 2022 | Uncategorized |

When discussing white-collar crimes, things like embezzlement and tax evasion are often at the top of the list. A less-talked-about form of white-collar crime, however, is healthcare fraud. Understanding exactly what healthcare fraud is, who might engage in it, and what the legal ramifications are is vital should you ever face charges.

What is healthcare fraud?

Healthcare fraud encompasses any intentionally dishonest claims or manipulation of the healthcare system with the result of gaining financial profit. According to The National Health Care Anti-Fraud Association (NHCAA), losses from these types of fraudulent claims total tens of billions of dollars annually. 

Who might engage in healthcare fraud?

The two main groups who might commit healthcare fraud are medical professionals and patients themselves. Medical professionals can include doctors, nursing homes, care or rehabilitation staff and home health aides. 

The scope of fraud could be as great as a doctor’s office routinely billing health insurance companies for services that patients didn’t receive or as narrow as an individual selling their own prescription medication. Regardless of the scope, those and other acts are still considered healthcare fraud.

Some other examples of healthcare fraud include:

  • A doctor’s office billing health insurance companies for more expensive services than a patient received
  • Forging prescriptions
  • Using identity theft to either use someone else’s existing health insurance or enroll in a new insurance plan using their personal information
  • An individual visiting multiple doctors in an attempt to get multiple prescriptions for medications either for themselves or to sell to others
  • A medical professional billing twice for the same services

Potential penalties and sentences related to healthcare fraud

Healthcare fraud is a federal crime punishable by a potentially weighty prison sentence as indicated by United States Code, Title 18, Section 1347. It’s possible that lesser charges may carry lighter penalties and sentences. Many factors go into calculating sentences and fines, so every situation differs.

It is important to know regarding fines and jail time that:

  • Those convicted of healthcare fraud may also be responsible for fines upwards of $100,000
  • Depending on the scope and severity of the charge, sentences could range from 5 to 20 years in prison 
  • Should the fraudulent acts result in someone’s death, the sentence could be as much as life in prison