What Is Healthcare Fraud?

Good Essays

What is healthcare fraud? Healthcare fraud is a criminal behavior, in which a person files a false claim, with the purpose of reimbursement. Healthcare abuse is similar, but focuses more on practices that do not match up with accepted solid financial, business, or medical practices, thus resulting in an avoidable cost or repayment for services that are not needed, or that fail to meet professionally familiar values for healthcare (Johns Hopkins, n.d.). While these both may have very different definitions, they are fall under the category of healthcare fraud and are both punishable by law when convicted. Healthcare fraud may be something as simple as a doctor over billing the insurance for only a few dollars, all the way on up to …show more content…

Restitution is another factor when convicting these criminals. Criminals convicted of healthcare fraud can pay restitution from hundreds, to multiple thousands of dollars, depending on the crime committed and the money improperly obtained as a result of their criminal behavior. Probation is another punishment that the judge may impose on the offender. Probation will limit the offender’s freedom, once released from the criminal justice system. Probation lasts at least twelve months (Criminal Defense Lawyer, 2017). As stated earlier, healthcare crimes can be something small or on the larger scale, but in the end, the result is the same, it is illegal and it will be punished, as has been shown here. Now that we have looked at the basic facts surrounding this horrific crime, let’s take a look at who is affected and a few different examples of healthcare fraud, to put this all into perspective. Medicaid and Medicare programs began in the 1960’s. While Medicare would constitute the Federal level, Medicaid falls within the state level and are vastly different entities. One article touched on the different areas of Medicaid fraud conducted by physicians. Research has shown that offenders will more than likely offend in multiple areas, instead of focusing on one specific area, to hopefully deter them from being caught (Payne & Grey, 2001). Some of these areas may include one or more of the following areas. First is fee for service reimbursement which is when

Get Access