Distinguished Knoxville Attorneys
Complimentary Case Evaluations
Back to Top

Understanding Healthcare Fraud

There are many types of fraud from identity theft to mortgage fraud but one in particular can come in many shapes and sizes and may scammers, patients, and others that interact with the system. Keep reading to learn more about healthcare fraud.

What Is Health Care Fraud?

Health care fraud involves using false or misleading information to collect benefits through insurance. Patients, doctors, and other individuals can commit health care fraud and use unauthorized benefits for their own gain.

In general health care fraud includes:

  • Billing for services that were never performed
  • Misrepresenting procedures to obtain payment for services not covered by insurance
  • Upcoding or billing for more expensive services than those performed
  • Accepting kickbacks for patent referrals
  • Waving copays or deductibles and billing the insurance company instead
  • Unbundling or billing at every stage of a single procedure as if there were multiple
  • Billing a patient more than the copay amount for treatments covered in full by insurance

Patients can also be guilty of health care fraud if they:

  • Use fake or expired ID to receive medications or medical services
  • Adding beneficiaries to a plan who are not eligible
  • Forging bills or receipts
  • Lending medical ID cards to other people

Health care fraud impacts all levels of the healthcare system. Patients could be forced to pay higher premiums while practitioners could be held accountable for significant losses. Insurance companies may also lose vast amounts of money when fraud occurs.

Tennessee Fraud Laws

For localized medical fraud cases, those found guilty could face felony charges and up to 30 years in prison as well as fines up to $25,000 in extreme cases. The hinge point of a fraud case is the fact that an individual intentionally used deception to deprive a person or entity of tangible or intangible benefits. According to state laws, fraud is accomplished through deceit, treachery, or unfair means. These elements are what the prosecution must prove to the court.

Federal Punishment

Because many healthcare fraud cases occur to take advantage of Medicare and Medicaid benefits, the federal government may have jurisdiction in some cases. The Centers for Medicare & Medicaid Services, the FBI, and other federal agencies can investigate and punish health care fraud.

Have You Been Accused of Fraud?

If you have been accused of health care fraud, you must contact an attorney immediately. Eldridge and Cravens, PC has extensive experience handing a variety of fraud cases including health care fraud. Our attorneys stand by our clients through every step of their case and provide support as fierce defenders and advocates.

Contact our firm today for more information.