Healthcare Fraud + Laws, Charges & Statute of Limitations

What is Healthcare Fraud?

Healthcare fraud is considered a white-collar crime. It consists of filing illegitimate health care claims to make profits. The fraudulent activity can be committed by either a healthcare practitioner or a consumer. Statistics show that healthcare fraud costs the United States government approximately $70 billion every year. The figure accounts for about 3% of the annual healthcare budget. Other statistics approximate the amount lost due to healthcare fraud to about $230 billion every year.

This is why the federal government has increased efforts meant to reduce healthcare fraud in the country. Several task forces, teams, and programs have been formed to deal with the abuse of Medicaid and Medicare health programs.

Common Forms of Healthcare Fraud Charges

The following is a list of common forms of healthcare fraud charges:

DEFENSE TEAM SPOTLIGHT

Todd Spodek

Lead Attorney & Founder

Featured on Netflix's "Inventing Anna," Todd Spodek brings decades of high-stakes criminal defense experience. His aggressive approach has secured dismissals and acquittals in cases others deemed unwinnable.

NY Bar Admitted Multi-State Licensed Federal Courts

Meet the Full Team

Legal Scenario: What Would You Do?

Scenario

You are a physician who recently received a letter from the Office of Inspector General stating that your billing patterns for certain diagnostic tests are under investigation. A former employee has allegedly reported that your practice routinely billed Medicare for comprehensive metabolic panels when only basic panels were ordered.

What kind of charges could I be facing, and how far back can the government look into my billing records?

Attorney's Answer

Healthcare fraud under 18 U.S.C. § 1347 carries penalties of up to 10 years in federal prison, or up to 20 years if the fraud resulted in serious bodily injury to a patient. The federal statute of limitations for healthcare fraud is generally six years from the date of the offense, meaning the government can scrutinize your billing records going back that far. You may also face additional charges under the False Claims Act (31 U.S.C. § 3729), which allows the government to seek treble damages and per-claim penalties for each fraudulent bill submitted. It is critical that you retain a defense attorney immediately and avoid speaking with investigators or altering any records, as obstruction could lead to separate charges.

This is general information only. Contact us for advice specific to your situation.

• Billing Medicaid and Medicare for services never rendered
• Changing of medical records
• Billing for services that are not covered as if they are covered
• Intentionally reporting improper diagnoses to inflate payments from state and federal government programs
• Selling or forging prescription medications
• Receiving kickbacks for patient referrals
• Billing for services that cost more than the intended one
• Waiving deductions or copays
• Practicing without a proper license

Examples of Healthcare Fraud by Consumers