You expect results. Attorney
Brian D. Poe delivers.

Understanding federal health care fraud

On Behalf of | Apr 29, 2023 | Health Care Fraud

Health care programs in Texas and other parts of the country are experiencing a major wave of fraud. This can take the form of submitting false claims to Medicare or Medicaid. It can also involve taking kickbacks, patient steering, and other knowingly fraudulent acts. Penalties for fraud of this type can be quite severe, involving fines and prison time.

What are the negative effects of fraud?

Health care fraud costs the government and taxpayers many billions of dollars per year. Some of the negative consequences that can arise from this type of fraud include:

  • Overutilization of health care programs
  • Higher costs to access and run these programs
  • Corrupt decision-making on the part of medical practitioners
  • Patient steering
  • Unfair and illegal competitive practices

What are the long-term consequences of fraud?

Fraud in the health care industry can have a wide range of negative consequences. Some of its ill effects can continue to plague the industry and patients for years afterward. The issue is complicated because many common fraud techniques are easy to pull off with next to no risk.

A health care provider may bill a patient’s insurance company for services that have never been rendered. In this case, the patient may never notice the exact details or precise cost of the supposedly received services. Meanwhile, the insurance company may pay these extra costs for many years.

How does fraud negatively affect patients?

Just as patients may not be aware that their insurance company is being defrauded, they may be equally ignorant that they are also being cheated. A patient may not realize that their doctor has chosen a more expensive treatment plan for the express purpose of enriching themselves.

A patient can also be duped into undergoing procedures that are not needed or may even place them at a higher level of risk. As in the case of insurance fraud, a long time can pass before the illegal activity is detected.