Trying the most complex issues
for over 30 years.

White collar criminal defense: What is health care fraud?

Health care is not just about taking care of those who are sick. It is a business. Health care companies and individual providers have every right to be paid for the services they offer. Wanting to get the most out of an insurance claim is not a crime, but those who are not careful may find themselves facing health care fraud charges. Health care providers in Colorado facing fraud charges can turn to a white collar criminal defense attorney for assistance addressing the matter.

What exactly is health care fraud? It comes in many forms, most of which have to do with billing practices. A few examples include:

  • Unbundling: Charging for individual steps of a procedure
  • Padding claims: Billing for serves not rendered
  • Upcoding: Charging for more expensive procedures than those actually provided
  • Over-billing: Waiving deductibles or copays in order to bill more to insurance

A few other forms of health care fraud are accepting money or other bribes for patient referrals, performing unnecessary services, and falsifying a diagnosis. Pharmaceutical and medical device companies are always trying to get physicians to prescribe their products, so they offer them incentives for doing so. There is nothing wrong with this as long as the patients to which they are prescribed could actually benefit from them. As far as performing unnecessary procedures and falsifying a diagnosis, patients should not be put through more than they need to be.

There is a fine line between what is acceptable for health care providers and companies in Colorado to do and bill for and what is considered health care fraud. Intent to defraud is needed for prosecuting attorneys to achieve convictions in these cases, and that is not always easy to prove. A white collar criminal defense attorney will have the ability to review the details of one’s case, question any evidence offered and help one put forth a strategic defense in order to achieve the best outcome possible.