What Is Healthcare Fraud?

Fraud in general is a white collar crime, and healthcare fraud is a specific type of fraud. Healthcare fraud usually involves an individual or healthcare provider defrauding insurance companies or the federal government's Medicare and Medicaid programs by submitting false insurance claims.

According to the Arizona Department of Insurance, insurance fraud is a class six felony that carries penalties of up to 10 years in prison and maximum fines of $150,000. Losses from all types of insurance fraud total billions of dollars a year.

Healthcare fraud is prevalent throughout the country, and extensive resources go into investigating and prosecuting it. Insurance companies have their own fraud units to detect fraud, as well. Here are some statistics reported by the Coalition Against Insurance Fraud:

  • In 2008, the National Health Care Anti-Fraud Association reported that out of the $2 trillion spent in the United States on healthcare every year, an estimated $68 billion goes to fraud.
  • The U.S. Department of Justice (DOJ) initiated 903 new healthcare fraud prosecutions in the first eight months of 2011, which was more than it prosecuted in all of 2010, showing an 85 percent increase in prosecutions in 2006.

In 2009, the U.S. DOJ teamed up with the Department of Health and Human Services (HHS) and created the Health Care Fraud Prevention and Enforcement Action Team (HEAT). Its main priority is to fight Medicare fraud. According to the HHS, between 2008 and 2011, actions taken by HEAT resulted in a 75 percent increase in criminal healthcare fraud charges. Through HEAT's Medicare Fraud Strike Force, investigators charged more than 1,400 defendants since 2007 who had billed the Medicare program more than $4.8 billion.

If you stand accused of healthcare fraud, it can mean the end of your profession and the start of time spent in prison. Put a strong criminal defense lawyer on your side. A law firm with white collar crime experience develops effective legal strategies, and a skilled criminal defense lawyer can help level the playing field and protect your rights.

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