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Health Care Fraud

In: Business and Management

Submitted By tallpaul85
Words 694
Pages 3
Insurance fraud occurs when any act is committed with the intent to fraudulently obtain some benefit or advantage to which they are not otherwise entitled to. Health insurance Fraud is becoming one of the top forms of fraud in America. Insurance fraud cost Americans billions of dollars every year as well as higher premiums. It is viewed as mostly a white-collar crime but it can come in many different forms. People who usually commit these kinds of frauds are motivated by greed for necessity or seeking wealth and luxury. There are several ways that healthcare companies are committing health insurance fraud. Examples of healthcare fraud include billing for services or supplies that were not provided, or billing Medicare for missed patient appointments, and altering CMS claim forms for higher payment amounts..

A successful prosecution of a health care provider that ends in a conviction can have serious consequences. The health care provider faces incarceration, fines, and possibly losing the right to practice in the medical industry. In Florida, it was reported that a physician was sentenced to 24 months incarceration and ordered to pay $727,000 in restitution fees for signing blank prescriptions and certificates of medical necessity for patients he never saw (Rudman, 2009). This is an example of the criminal liability that can result from healthcare fraud. In the case United States ex rel. Donigian v. St. Jude Medical agreed to pay $16 million to quiet allegations of paying kickbacks to physicians. The whistleblower was able to provide detailed insider information as to the nature of the kickbacks, which ranged from entertainment to sporting event tickets and other gifts. The relator in this case was awarded $2.64 million.

Congressional legislation requires that health care insurance pay a legitimate claim within 30 days. The Federal Bureau of...

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