You may still be reeling after receiving the notice that you were under scrutiny for crimes of fraud in your medical office. Whether you are a physician or a billing administrator, investigators will likely examine every aspect of your job to find the point at which fraud is likely to have occurred.
Even though you may have only recently learned that authorities suspected you of medical fraud, detectives have probably been on the case for months. Depending on the size of your health care facility and the depth of the suspected fraud, the investigation likely includes multiple agencies from the federal, state and local jurisdictions. This is because the federal government regulates the health care industry, so embezzlement of this type is usually a federal crime.
Medical embezzlement and its consequences
Federal investigators may be looking for evidence that you had a role in any of the following:
- Billing patients for services they never received or services that were more expensive than those they received
- Performing medical procedures on patients who did not need them
- Falsifying patient records to match unnecessary tests or procedures
- Billing patients for services that their insurance covered in full
- Separating bundled procedures and billing them individually
- Using a patient's identification to make false insurance claims
You may be able to see how dangerous these schemes can be for the patient and why investigators take medical fraud so seriously. Patients with false diagnoses on their health records may receive inappropriate treatment for true conditions. They may also max out of their lifetime insurance benefits and be left without coverage. Falsified medical records can also affect a person's ability to pass a physical exam for employment or life insurance.
Defending against the long-term costs
Federal law sets some penalties for health care fraud. If the court convicts you of stealing money through identity theft or other schemes, you could be facing several years in federal prison. If the crime of which investigators accuse you resulted in the injury or death of a patient, the court may double your prison time. You may even face a life sentence. In addition, you will probably have to pay substantial fines and make financial restitution.
Because of this, things may not go well for you, even if the suspected fraud is merely an innocent mistake or confusion over billing procedures. Federal agencies work tirelessly to bring fraudsters to justice. Facing decades in prison if convicted, you are likely concerned for your future. An attorney with experience in fraud, particularly health care fraud, may make the difference for you. Your attorney will build a strong and sophisticated defense and work to achieve positive results for your situation.