What You Need to Know About Healthcare Fraud

Although fraud is generally considered a white collar crime, healthcare fraud is a special type of fraud. Healthcare fraud tends to involve an individual or healthcare provider submitting false insurance claims to defraud insurance companies or to take advantage of the federal government's Medicare and Medicaid programs.

Insurance fraud is a class six felony that carries penalties of up to 10 years in prison and maximum fines of $150,000. According to the Arizona Department of Insurance, losses from insurance fraud total billions of dollars every single year. Healthcare fraud is a major issue throughout the United States and an extensive amount of resources go into investigating and prosecuting these crimes. In fact, insurance companies have their own fraud units to detect fraud too.

According to the Coalition Against Insurance Fraud:

  • The National Health Care Anti-Fraud Association reported in 2008 that of the $2 trillion spent on healthcare every year in the United States, roughly $68 billion goes toward fraud.
  • The U.S. Department of Justice (DOJ) initiated 903 new healthcare fraud prosecutions in the first eight months of 2011. This is more than what was prosecuted in all of 2010 and accounted for an 85 percent increase in prosecutions since 2006.

In 2009, the U.S. Department of Justice (DOJ) teamed up with the Department of Health and Human Services (HHS) to create the Health Care Fraud Prevention and Enforcement Action Team (HEAT). The main priority of HEAT is to combat Medicare fraud throughout the country. According to the HHS, actions taken by HEAT resulted in a 75 percent increase in criminal healthcare fraud charges between 2008 and 2011. Through HEAT's Medicare Fraud Strike Force, investigators were able to charge more than 1,400 defendants who were responsible for billing the Medicare program over $4.8 billion.

If you have been accused of healthcare fraud, you should immediately speak with an experienced lawyer to determine your legal options. At Nesci & St. Louis, we use our years of experience and our knowledge of the law to develop effective legal strategies that are unique to your situation. Let our team of attorneys help you level the playing field and protect your rights.

Contact our Tucson criminal defense attorneys to schedule your free consultation today.