Common Types of Healthcare Fraud in Orlando

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Anyone accused of healthcare fraud faces severe allegations that can lead to an avalanche of difficulties which may ultimately bar him or her from working in healthcare altogether. In many situations, healthcare fraud charges are federal charges, which means they are among the gravest criminal charges a person may face. If you are in this situation, or if you are under investigation for healthcare fraud, you need to seek the counsel of a lawyer with familiarity fighting federal healthcare charges immediately.

Instances of healthcare fraud in and around Orlando are on the rise. The crime frequently involves medical providers scamming government-funded programs like Medicaid, Medicare, and Tricare to increase their reimbursements. Federal and state authorities are attentive to the issue, which places all medical providers who participate in these programs under a microscope. In this climate, the smallest error can trigger an investigation. It is up to you to seek experienced and aggressive representation to fight the charges against you.

Why is Healthcare Fraud an Issue in Orlando?

The effects of a white-collar crime like healthcare fraud extend far beyond those who rely on government programs for healthcare; these schemes affect virtually anyone who pays taxes. Healthcare fraud can cost healthcare companies billions of dollars, which they afford by increasing the costs of their services. In turn, the federal government may raise taxes to cover the increased costs of running such programs.

Patients’ wellbeing is also at stake. Doctors who order unnecessary treatments take resources away from those who really need them. In turn, patients must wait longer to receive critical care. Physicians inclined to over-treat patients are more likely to commit medical malpractice and physically hurt a patient who did not need the procedure the physician performed for profit. Doctors who order too many tests increase the odds of false diagnosis, misdiagnosis, or over-diagnosis.

Lastly, as the overall cost of treatments increases due to overtreatment and fraud, private insurers also raise insurance premiums. We all stand to lose when greedy healthcare providers take advantage of government-run healthcare.

Examples of Healthcare Fraud in Central Florida

Billing & Coding Errors

The most common example of a healthcare fraud scheme is that of committing billing and coding errors. These issues occur fairly often, considering that providers who participate in Medicare, Medicaid, and Tricare must submit to a complex regulatory system that includes several requirements to obtain reimbursements for services, supplies, medications, and durable medical equipment. These requirements change frequently, making compliance a challenging task.

Billing and coding errors include mistakes like:

  • Billing twice or billing the government and a private insurer for the same service, supply, medication, or equipment
  • Billing for operational expenses and other non-allowable costs which are not eligible for reimbursement from the government
  • Billing for services at stand-alone rates instead of the reduced “bundled” rate (referred to as “unbundling”)
  • Billing for services at a higher rate than the one prescribed by the applicable program regulations (“upcoding”)
  • Billing for other services or costs that are ineligible to receive reimbursement from federal programs, including services provided by unlicensed or excluded medical providers and unnecessary services

Accepting Bribes

Federal healthcare laws prohibit incentives in exchange for referrals. Individuals like doctors, marketing representatives of pharmaceutical companies, and business owners may face prosecution for violating the statute for offering or providing payment in exchange for patient referrals.

The Anti-Kickback Statute prohibits the following kinds of bribes or “remunerations”:

  • Cash payments
  • Discounts for services, supplies or equipment
  • Free or below fair market value use of clinic space, equipment, or healthcare staff
  • Payments to family members
  • In-kind gifts like airplane tickets
  • Certain marketing commissions

Under the Stark Law, physicians may not refer patients to a fellow medical service provider with whom they or their family members have a financial relationship or in which there is a financial interest. Self-referrals undermine trust in the medical profession.

The Stark Law applies specifically to practicing physicians and prohibits them from receiving compensation for their referrals for medical services that are paid for by Medicare, Medicaid, or Tricare.

Prescription Drug Fraud

In the midst of the opioid crisis, the government has strengthened its efforts to crack down on prescription drug fraud. The Department of Justice is devoting new technology and increased resources to targeting physicians, pharmacists, and other healthcare providers suspected of improperly prescribing, dispensing, and administering opioids. There is now an Opioid Fraud and Abuse Detection Unit dedicated to unraveling opioid-related healthcare fraud.

Prescription drug fraud is a broad term that encompasses a variety of civil and criminal offenses under multiple federal statutes. Several government agencies may conduct investigations in this area, including the DOJ, the DEA, and others. Practices such as the following generally raise suspicion of prescription drug fraud:

  • Dispensing more medication than was prescribed
  • Shorting and refill schemes
  • Falsifying prescriptions
  • Illegally importing prescription drugs
  • Inaccurately reporting test results to order medically-unnecessary drugs
  • Prescribing medicines without an in-person medical exam
  • Prescription drug diversion
  • Selling fraudulent prescription drugs

Compound pharmacies have also drawn the attention of federal law enforcement authorities for acts of healthcare fraud, such as kickbacks and overbilling for compound medications for falsely marketing compound drugs as FDA-approved substances.

Penalties for Healthcare Fraud

Federal crimes lead to the toughest penalties in existence. A crime like healthcare fraud can lead to hundreds of thousands of dollars in fines as well as years in federal prison. In many scenarios, the convicted party can no longer work in the healthcare industry. A physician, for instance, may lose his license to practice medicine.

Much is at stake when you face federal charges for healthcare fraud. Do not hesitate to contact a lawyer who will stand up for you. At the Umansky Law Firm, we have decades of experience defending federal charges. Call 407-228-3838 for a free consultation.