As the US shifts toward a privately run, for-profit healthcare system, it’s natural for hospitals, doctors and clinics to want increased profits. However, in the rush to profitability, some providers may commit fraud against public programs such as Medicaid and Medicare. Fraud can occur when a provider lies to an insurer about performance of a medical procedure to receive a payout. Read on to learn about the criminal nature of Medicaid fraud, and to learn how a Medicaid Fraud Attorney Orange County NY can help to defend against it.
Is Medicaid Fraud a Crime?
Health insurance fraud is addressed by HIPAA (the Health Insurance Portability and Accountability Act), which made it a federal crime with a prison term of ten years or less. If a provider violates this act, they will likely end up in a minimum-security prison that houses those guilty of white-collar crimes, and they may face significant fines.
Examples of Fraud
There are as many types of healthcare fraud as there are perpetrators. The most frequently seen type is billing for procedures that were never done, or charging more than the services actually cost. Low-income and homeless people are often invited to get free vaccinations, or to sign a sheet for a nominal payment, and the provider claims to have given a service.
These schemes are often very complex and extremely lucrative. However, insurance companies themselves can commit fraud, in the form of delayed and denied payouts. For instance, an agent may tell patients that an incident has been fully investigated when it hasn’t, but more frequently, insurers are guilty of violating the “fair dealing and good faith” promise.
Can an Attorney Help a Person Involved in a Medicaid Fraud Case?
As mentioned previously, healthcare fraud can be hidden and complex. If a person believes they have been victimized by healthcare fraud, Mark Aberasturi can help them determine how to pursue the right remedy for the harm they’ve suffered. Alternatively, if one believes they have been unfairly accused of commission of healthcare fraud, a Medicaid Fraud Attorney Orange County NY can provide courtroom representation, and they can defend the client against the false accusations.