Healthcare Fraud Charges: Penalties and Possible Defenses

Last Updated: 

November 7, 2022

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Healthcare fraud charges refer to cases when a healthcare provider intentionally tries to defraud or misrepresent medical claims to the government to avoid taxes or earn illegal money. And the reason why healthcare law is complicated is that not one law regulates the fraud charges. But, the defendant should consider numerous laws to avoid fraud charges.

Healthcare fraud charges and abuse charges come at a huge cost, both individually and to the economy at large. The FBI reported that healthcare fraud in America alone costs tens of billions of dollars every year. Fraud cases can involve all the medical healthcare providers, including a doctor and an entire clinic.

 As a defendant, you could be charged for anti-kickbacks, referrals, and false claims with serious consequences, including heavy penalties, prison, and even it can cost you your medical licence.

 Some of the common healthcare fraud charges include:

  1.  Selling medical items at higher prices than usual ( upcoding)
  2.  Fake plans of treatments and medical records to justify payments
  3.  Recommending unnecessary diagnoses and medications for maximising payments.
  4.  Unlawful prescriptions
  5.  Kickbacks to sell their services.
  6. False claims

What are the Penalties and Sentences for Healthcare Fraud Charges?

If a healthcare provider gets convicted for fraud, anti-kickback, conspiracy, or false claims, they will have to face severe penalties. Though it will highly depend on the particular violation, you can face the following penalties:

  1. If the potential fraud results in death, it can cause you life in prison, 20 years for serious bodily injury, and ten years for other violations.
  2. The defendant can face up to five years in prison for false claims.
  3. In the case of an anti-kickback statute, up to 10 years for a felony and one year for a misdemeanour.
  4. In case of a health care fraud conspiracy, the defendant can face up to 10 years in prison.

 Are There Any Possible Defences?

While there are heavy penalties for healthcare fraud charges, you can also avoid these charges if you have the following defences:

  1. The government must have sufficient witnesses or evidence to prove your fraud. Without it, you cannot be convicted.
  2. Set up a compliance program with a lawyer. Professional fraud defense attorney at Hickey & Chung LLP suggests that a lawyer will help you make a thorough compliance plan to detect any sort of fraudulent activity in your case. Your lawyer can use this plan to prove your lack of intent to commit fraud, which can help   you avoid criminal charges.
  3. You must have the intention to cheat the government to commit fraud. If you accidentally made a mistake or mishandled the bills and payment, you will not be charged for healthcare fraud.

The Bottom Line

Cases of healthcare fraud have been rising in the healthcare industry. Healthcare providers must take action to control the rising fraud cases, as 60% of faulty claims are accidentally mishandled by the providers.

They should invest in proper training and education to minimise the chances of fraud, either on purpose or by accident. Moreover, they should be well aware of the severe consequences that healthcare fraud can have on the entire healthcare system. 

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