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 take shortcuts.
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 Nicolai 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.