Healthcare fraud costs the nation approximately $68 billion per year. This means it happens more often than expected in subtle ways you might fail to detect. However, by understanding how it occurs in Texas, you can take measures that can prevent you from making mistakes that might get you in trouble with the law.
Understanding healthcare fraud
Healthcare fraud is a white-collar crime that involves intentional deception or misrepresentation made by a person or entity with the knowledge that the deception could result in some unauthorized benefit to themselves or some other party. It’s different from abuse in that abuse is a practice that, although not fraudulent, may result in unnecessary costs to the healthcare system.
Healthcare fraud can be perpetrated by patients, providers, or third-party payers. It can involve billing for services that were never rendered, “upcoding” (billing for a more expensive service than the one that was actually provided) or providing kickbacks for referrals. It can also involve using someone else’s insurance information to receive treatment or prescription drugs.
What to do when facing a health care fraud charge in Texas
White-collar crimes are among the most severely punished in the U.S., and healthcare fraud is no exception. A conviction for healthcare fraud can result in heavy fines and up to ten years in prison per count, as well as the loss of your professional license.
If you’ve been charged with healthcare fraud, it’s imperative to review your case meticulously to devise a good defense strategy to use. For instance, if your employee committed the crime without your knowledge, you may be able to get the charges against you dropped. You should also look into whether there’s any evidence of entrapment by law enforcement.
Preventing healthcare fraud in your facility
You can take measures to prevent healthcare fraud in your facility by implementing policies and procedures that will make it more difficult for employees to commit fraud. For example, you can require that all employees submit documentation for their expenses, create a “whistleblower” policy to encourage employees to report any suspected fraud, and institute regular auditing procedures.
Healthcare fraud is not only costly to the government and taxpayers, but it also drives up the cost of health insurance and medical care for everyone. It affects both individuals and businesses alike. Hence, the FBI is the primary agency that deals with it for both private and federal facilities.