The United States has one of the most complicated healthcare reimbursement
systems of all industrialized nations. With hundreds of private insurance
providers and several government programs involved, it's easy to see
how healthcare fraud can happen. Claims processors for hospitals and clinics,
who get tired of jumping through hoops just to be paid, are tempted to
However, what originally looks like fraud often turns out to be an honest
mistake. If you or someone in your healthcare business has been charged
with fraud, keep in mind that the prosecution must prove you intentionally
used deceptive practices to defraud the government or a private insurer.
Common Situations Leading to a Healthcare Fraud Charge
Medical professionals are only human and are bound to make mistakes when
stressed or confused. The following are examples of situations that may
cause someone to face a healthcare fraud charge when he or she simply
made a mistake:
- Submitting a claim to a private insurance company or a government program
for services the client never received. The person doing the billing may
mix up patients or bill for a service the patient was supposed to receive
but cancelled his or her appointment instead.
- When a patient receives one service but the provider bills for another,
this is called upcoding under California law. It often casts suspicion
on the biller when the incorrect service is more expensive.
- Duplicate billing for the same service. This can happen when the insurer
is slow to pay and the second bill and payment cross in the mail.
Secure Your Defense Immediately
Facing a charge of healthcare insurance fraud is intimidating, especially
when the accuser is the federal government. The Law Office of Nic Cocis
& Associates is here to help. We encourage you to
contact us as soon as you are charged so we can promptly prepare your defense. We
represent individuals from the Murrieta, Temecula, Wildomar, Menifee,
Lake Elsinore, Hemet, Banning, Corona and Riverside areas.