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What is Healthcare Fraud?

Because the healthcare field is constantly and rapidly changing, there is a large surge in incidents of healthcare fraud. Healthcare fraud is a special type of crime which involves a doctor, nurse, hospital administrator or nursing home manager willfully misleading an insurance company or the government about the charges or costs of healthcare. This type of crime can be serious and is most often associated with Medicare or Medicaid fraud. This type of fraud is considered a white-color crime and results in unjust profit for the perpetrator. Practitioner schemes include, but are not limited to:

  • Individuals obtaining subsidized or fully-covered prescription pills that are not needed, then selling them on the black market for a profit
  • Billing by practitioners for care that was never rendered
  • Altering the dates, description of services, or identities of members or providers
  • Billing for a non-covered service as a covered service
  • Modifying medical records
  • Prescribing additional or unnecessary treatment
  • Use of unlicensed staff
  • Filing duplicate claims for the same service
  • Intentional reporting incorrect diagnoses or procedures to maximize the amount of payment
  • Accepting or giving kickbacks for member referrals
  • Waiving member co-pays

There are also ways in which members can commit healthcare fraud, including:

  • Providing false information when applying for coverage or services
  • Selling prescription drugs
  • Using benefits for non-medical related purposes
  • Using another’s insurance card

When an individual is accused of healthcare fraud, the charges should be taken seriously.

What Should I Do If I Am Accused of Healthcare Fraud?

If you have been accused of healthcare fraud, contact a criminal defense attorney, like those at the Oswalt Law Group in Phoenix, immediately. Healthcare fraud case are often complicated and difficult to win without the help of a qualified attorney. Retaining an attorney who has experience dealing with complex medical fraud cases may ultimately save you a conviction and harsh penalties, including thousands of dollars in fines and months or even years in prison. The team at the Oswalt Law Group has the experience, skill and resources you need to build a solid defense and set you up for the best chance at a positive outcome. It is important that you protect and exercise your rights by retaining a criminal defense attorney. The Oswalt Law Group is here to help you through each step of the process, aggressively representing you and help you develop a solid defense.

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