Health Care Fraud - Patients Beware!

Health care fraud is the act of knowingly and willfully executing or attempting to execute a scheme to defraud any health care benefit program in connection with the delivery of or payment for health care benefits or services or obtains any property of the health care benefit program by false representations. The law is applicable to fraud targeting private insurance agencies, insurance programs responsible for medical payments and public health care programs.

The law strictly prohibits any individual from knowingly and willfully falsifying, concealing or covering up any material fact, making a false statement, using or making any false or fraudulent document in connection with the delivery of or payment for health care benefits or services. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was enacted to help fight health care fraud. Due to this act, health care fraud is a federal crime.

There is deliberate presentation of false materials and data to health care benefit programs and insurance programs. Creating the false representation will guarantee offenders extra profit due to falsification of payment and tax claims thus larceny is highly associated with the act. Most offenders are also charged with larceny in addition to acts of fraud that targets programs.

Who Are The Victims?

Most patients with chronic and intermittent conditions are the usual targets of health care fraud. Since these individuals invest and spend a lot of time, money and documentation on insurance coverage and repeated necessary treatments, it is very easy to falsify one or more details in order to provide additional charges to be gained by offenders. The Federal Trade Commission and the Food and Drug Administration are highly cautioning people with questionable records.

Although several agencies, programs and institutions constitute health care, there are certain areas that acts of fraud usually exist in. Some features are billing materials and services which were not really given to patients and documented properly at all, billing unnecessary services and materials, duplicate billing, billing services by an unqualified personnel, unbundling, upcoding, changing identification, identification numbers and medical records and failure to refund.

Other Characteristics of Health Care Fraud

Other unlawful acts included in health care fraud are failure to secure licenses for practicing professionals, patient abandonment and failure to follow rules and regulations stipulated in the program or institution, joint ventures between the persons involved, pressuring persons to pay added fees or soliciting in excess and overuse or lack of intervention and treatment to patients.

There are a number of defenses that can be given during proceedings against health care fraud. The defendant may claim that there only was minimal loss to the health care program, the conduct was only the result of further negligent actions by other personnel and there was reasonable ground for the professional to believe that extra payments were necessary.

Punishment For Health Care Fraud

Any individual included or not included in the health care program or institution can be penalized in fines and imprisonment if found guilty of health care fraud. Fines can range from $1,000 to $1,000,000 depending on the profits made and damages incurred to patients and the agency. Jail time can last from six months to ten years. If a patient dies as a result of the criminal act, the offender can be imprisoned for life.

We all want to think we are safe but are we? If you want to know more about the different types of crimes committed today, RecordsSiteReviews.com is offering FREE ACCESS to its Criminal Records Information section. If you have a nagging suspicion on someone, run a criminal check on him or her today !