Residents of California should understand that fraud happens in the health care space. Normally, people associate fraud with purely financial crimes where a person deceives in order to get money or other things of value. Medical professionals are supposed to act in the best interest of their patients, and most of them do, but a few use their position to commit crime.
Understanding fraud in health care
White-collar offenses in health care fraud are typically related to billing. Providers will sometimes bill insurances for services that they actually didn’t render. This is a problem for government-funded programs like Medicare and Medicaid. In effect, some of these providers are stealing from everyone who pays taxes in the United States.
Getting falsely accused of fraud
There are other forms of fraud in health care. Some medical practices will have a provider with a lower-level credential perform the actual services and then bill the patient or insurance company as though a higher-level physician rendered the services. This kind of fraud is damaging to patient trust, and it also puts the people doing the work in an awkward position. They may not know it’s happening. If they do, they are caught between the imperative to blow the whistle and the financial consequences of losing their job. They might even be charged with fraud themselves and need to prove that they weren’t involved in the scheme.
If you’ve been wrongfully accused of health care provider fraud, it’s important to challenge the charges. An attorney may be able to help you understand what’s happened to you and how to mount a defense against charges of fraud.