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Common acts that can lead to federal health-care fraud charges

The health-care insurance system is intended to provide patients with the best possible medical treatment while guaranteeing that health-care providers who perform services get paid, whether in Louisiana or another state. Unfortunately, sometimes patients and health-care providers can face allegations of federal health care fraud if Medicare discrepancies occur. Patients and health-care providers should understand what sort of common behaviors and mistakes can lead to fraud charges and thus how to avoid them.

Patients can be charged with fraud if they allow other people to use their identity to obtain medical treatment. A patient also can be charged with fraud if he or she uses insurance to pay for prescription drugs that have not been prescribed by his or her physician. For their part, health-care providers can be charged with fraud if they bill for services that were never provided. In addition, physicians can be charged with fraud if they charge more for a certain procedure than it actually costs. Providing unnecessary services and falsifying patient procedures, surgeries and tests specifically for financial gain are also common types of fraud among doctors.

Anyone who is charged with fraud arising from such allegations is legally presumed innocent until proven guilty in a court of law by a judge or jury. These charges can thus be contested. It is in a criminal defendant's best interest to craft a strong criminal defense. In most cases, people are charged with federal health-care fraud because of errors in documentation or poor record keeping. If a defendant can show that the services or procedures were actually necessary, for example, then acquittal may follow.

The penalties for federal crimes vary, as do the requirements for a conviction. It is therefore important to determine the severity of each charge because each offense may require its own defense strategy. To learn more about how defendants can protect their rights, they should seek legal counsel.

Source: PA Insurance Fraud Prevention Authority, "Health insurance fraud," Accessed on Dec. 10, 2014

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