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Facing accusations of health care fraud

As a Florida medical professional, you are under the scrutiny of many agencies, perhaps the insurance industry most of all. You may spend a great deal of your own time handling your practice's insurance billing, and over the years you may have watched the mountains of required paperwork grow higher with each new regulation. Many of these the government and insurance industry established to fight fraud.

Fraud in the health care industry is not uncommon, and you may know of respected practitioners who became entangled in the lure of making extra money to the detriment of their reputations, careers and freedom. In fact, if you have recently learned that you are under investigation for committing fraud, you may have legitimate concerns for your own future.

Examples of health care fraud

Some studies show that about 10 percent of all medical costs relate to fraud, especially Medicare fraud. Taxpayers pay billions of dollars to cover fraudulent Medicare claims because it is relatively easy to commit this crime without detection. If you are responsible for your office's insurance claims, you may have unwittingly drawn attention to yourself. Perhaps someone in your office, a patient or another medical professional alerted authorities that something seemed amiss in your practice. They may have accused you of any of the following common acts of fraud:

  • Billing patients for treatments or other services you did not provide or upcoding to more expensive treatments
  • Performing tests or treatments on patients when they don't need them
  • Billing for a service insurance does not cover by coding it as a billable service
  • Billing a patient for each step of a procedure instead of as one amount for the entire service
  • Charging a patient more than the insurance copay
  • Accepting fees for referring patients to other providers

You are probably aware of the danger of committing any of these acts of fraud. Not only do doctors place their careers and futures in jeopardy, but they also may end up placing patients' lives at risk. Misrepresentations on a patient's record may cause other health care providers to prescribe dangerous or inappropriate treatments that could cause harm.

The penalties for white collar crimes like health care fraud can include enormous fines, prison sentences and loss of your license to practice medicine. If you are facing these serious accusations, you would do well to seek legal representation in the earliest moments of the investigation into your medical practice.

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Attorney Warren Lindsey has been awarded the following credentials:

Our other attorneys and our firm have been awarded the following credentials:

  • Rising stars | Matthew P. Ferry |SuperLawyers
  •  | MICHAEL BARBER |SuperLawyers
  • Orlando County Bar Association
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