Health Care Crimes

  • medical-appointment-doctor-healthcare-clinicHealth insurance Fraud: Insurance fraud happens when any act is committed with the criminal intent to fraudulently obtain some benefit to which a person is not entitled. It also happens when someone willfully denies some benefit that is due and to which an individual is entitled.
  • Medic aid providers include doctors, dentists, hospitals, nursing homes, pharmacies, clinics, counselors, personal care/homemaker chore companies, and any other individual or company that is paid by the Medicaid program. If a provider intentionally misrepresents the services rendered, and therefore increases their reimbursement from Medicaid, Medicaid fraud has occurred.
    Medicaid fraud includes …

    • Billing for medical services not actually performed, known as phantom billing
    • Billing for a more expensive service than was actually rendered, known as up coding
    • Billing for several services that should be combined into one billing, known as unbundling
    • Billing twice for the same medical service
    • Dispensing generic drugs and billing for brand-name drugs
    • Giving or accepting something in return for medical services, known as a kickback
    • Bribery
    • Providing unnecessary services
    • False cost reports
    • Embezzlement of recipient funds