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Are you the subject of a health care fraud investigation?

On Behalf of | Aug 28, 2019 | Firm News

As someone who works in the health care industry, you face a lot of pressure and responsibility. You undoubtedly want to make sure that you treat your patients fairly and correctly, but you also know that any suspicion of wrongdoing could quickly fall back on you. Though problems with medical malpractice claims may first come to mind with this type of issue, you could also stand accused of health care fraud in some cases.
You may want to remember that you are not guilty just because you come under suspicion. However, it is wise to start trying to understand your legal options if an investigation into your actions begins. Preparing ahead of time may allow you to feel more at ease in the event that authorities do charge you with this white-collar crime.

What actions are considered fraudulent?
If you come under suspicion of fraud, investigators will look to determine whether any of the following actions may have occurred:

  • Billing for more expensive procedures than you actually performed
  • Billing each step of a procedure at a separate cost rather than billing for the procedure as a whole
  • Performing services that a patient does not need in efforts to obtain insurance payouts
  • Providing false patient information, particularly regarding a diagnosis, in efforts to justify additional testing, procedures or other services
  • Accepting benefits for making patient referrals
  • Falsely claiming that an elective procedure was medically necessary in order to receive insurance payouts
  • Overbilling the insurance carrier by waiving patient co-pays or deductibles
  • Overbilling patients
  • Billing for services or procedures that you never performed

Though you may feel disheartened that someone would accuse you of a crime, you cannot count on the investigation simply going away. Instead, you may want to prepare for the possibility of having to defend yourself against serious criminal allegations.
How can you prepare?
As soon as you learn of the investigation into your conduct, you may want to start exploring your legal options. Consulting with a New York attorney from the first signs of suspicion could help you ensure that you have the ability to build a meaningful defense against any allegations that may come against you. Your legal counsel could help you understand what an investigation may entail, explain what could happen if charges come about and discuss how you can help yourself fight allegations.