Battling Charges of Using Mail to Defraud Federal Health Benefit Programs

Health care fraud is a serious issue that affects everyone. It raises health insurance premiums, exposes people to unnecessary procedures, and increases taxes. The FBI is the main agency investigating health care fraud for federal and private insurance programs. They work with other agencies like the Centers for Medicare and Medicaid Services to catch scammers. But even regular folks can help stop fraud by watching for common scams and reporting anything suspicious.

What is health care fraud?

Health care fraud happens when someone lies to get money or benefits they shouldn’t from a health care program. Doctors, patients, or anyone else can commit fraud. Some examples are:

• Billing for services that weren’t provided
• Billing for more expensive services than were actually done
• Performing unnecessary tests or procedures to get more money
• Using someone else’s insurance without permission
• Selling prescriptions or medical equipment that were meant to be free

Prosecutors go after health care fraud under federal laws like the Health Insurance Portability and Accountability Act (HIPAA), the Anti-Kickback Statute, and others. Penalties can include big fines and years in prison. But catching fraudsters isn’t easy with such a huge, complex health care system.

How scammers steal your info

Scammers use sneaky tactics to get your personal info and bill your insurance. Here are some common techniques:

• Pretending to be from Medicare – They call saying you need a new card or you’ll lose coverage. But Medicare never calls out of the blue about cards or coverage.
• Charging for free services – Scammers offer things like “free” genetic testing but make you give insurance details to pay a “processing fee.”
• Using fake grants – Scammers create websites offering grants from the Department of Health and Human Services in exchange for personal info.
• Requiring upfront fees – Con artists ask for money upfront before medical services are rendered.

Once scammers have your insurance info, they bill for services you didn’t get. Or they use your identity to get care and stick you with the bill.

How to protect yourself

You can help stop health care fraud by taking a few precautions:

• Guard your insurance card like a credit card. Don’t share it unless absolutely necessary.
• Get all info in writing before agreeing to anything. Don’t be rushed into a decision.
• Research companies online or with the Better Business Bureau before doing business.
• Discuss offers and appeals with a trusted friend before responding.
• Use call blocking to reduce telemarketing calls.
• Read everything carefully before signing or sending money.

Also, review bills closely to spot any charges for care you didn’t receive. Report anything suspicious to your insurance company or the FBI.

Fighting criminal charges

If you’re accused of health care fraud, don’t panic. These cases can be fought, but you need an experienced lawyer. Charges might come from:

• The FBI
• Medicare auditors
• State investigators
• Insurance company fraud units

The first step is understanding the charges so you can start building a defense. For example, billing errors could simply be mistakes, not intentional fraud. Your lawyer can also argue things like:

• You acted in “good faith” based on unclear rules
• You were misled by marketing claims
• You tried to fix errors once discovered

Effective defenses depend on the specifics of each case. But in general, it helps to show you didn’t mean to break the law. You just got caught up in a confusing system. This can reduce charges or penalties.

Avoiding trouble in the future

If you resolve fraud accusations, you’ll want to avoid more trouble down the road. Some tips:

• Consult lawyers before taking actions that regulators may view as fraudulent.
• Conduct internal audits to catch and correct billing errors.
• Train all staff on proper billing practices.
• Report even minor issues to show you’re trying to comply.
• Keep meticulous records as proof of medical necessity of services.

Health care rules are incredibly complex, so misunderstandings happen. But showing you want to follow the rules can help if questions arise again.

The harm of health care fraud

Health care fraud seems like a victimless crime, but it hurts everyone. Here are some major effects:

• Higher insurance premiums – Losses from fraud get passed on to consumers through higher premiums and out-of-pocket costs.
• Higher taxes – Medicare and Medicaid fraud costs taxpayers billions since these programs are funded by federal and state taxes.
• Dangerous practices – Some frauds, like unnecessary surgeries, put patients at serious risk just to make money.
• Less access to care – As costs rise, people get priced out of health insurance and care.

So while it may seem harmless on the surface, health care fraud actually hurts millions of Americans. For the good of the public, prosecutors take these cases very seriously.

Conclusion

Health care fraud is a massive problem that everyone can help fix. Watch for scams trying to steal your info. Review all medical bills closely. And if you’re accused of fraud, fight back with an experienced legal team. With vigilance from patients and providers alike, we can reduce fraud and protect access to quality, affordable healthcare.