Medicare Fraud + Laws, Charges & Statute of Limitations.

What is White-Collar Crime and Healthcare Fraud?

White-collar crime is a nonviolent, financially motivated crime committed by someone working for the government or a business. An example of white-collar crime is healthcare fraud. Healthcare fraud occurs when there is an intentional submission of false information to receive greater financial benefits.

Healthcare is one of the largest industries. The United States spends approximately $2 trillion each year on healthcare. Unfortunately, the United States also spends almost $68 billion each year on healthcare fraud.

Types of Healthcare Fraud

Due to the large industry of healthcare, fraudulent activity has been rampant over the last two decades. As a result, the government has put into action task forces to diligently monitor and handle healthcare fraud. The majority of healthcare fraud occurs with Medicaid and Medicare.

There are many ways in which a business or government professional can perform healthcare fraud. A top culprit is overbilling or billing for services that are non-existent. Another common fraudulent activity is increasing the cost of a medical procedure by billing for each step of the procedure.

Mis-diagnosing or the false diagnosis of a patient in order to receive financial gain is healthcare fraud. When a physician's office or hospital does not accurately classify a procedure with the purpose of being compensated, they are guilty of healthcare fraud.

Billing more for a service than what it is worth is called upcoding. Upcoding allows the organization to bill for more money and this is considered healthcare fraud. Kickbacks and incentives for patient referrals or tampering with deductibles and copays are all criminal activities.

Medicare Fraud Laws