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Health Care Fraud Defenses

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What Is Health Care Fraud?

Health care fraud occurs when a person seeks to deceive a health care provider in order to pay less on their health care coverage. This type of fraud is often accomplished through the use of fake forms, forged signatures, deliberate misinformation, and other fraud methods. Like all other forms of fraud, health care fraud is illegal and may result in various criminal and/or civil consequences.

Are There Any Defenses for Health Care Fraud?

Health care fraud charges are sometimes associated with certain defenses. These include:

  • No Knowledge: Health care fraud generally must be intentional, and the defendant must have intended to deceive the other party in order to be found guilty.
  • Coercion: It can sometimes be a defense if the person was coerced (forced) to engage in fraud, for instance under threat of physical harm.
  • Unclean Hands: In some cases, recovery may be barred if the party seeking a remedy has engaged in the same conduct, such as if the plaintiff also engaged in fraud. This is often a remedy in cases where the party is seeking equitable relief.

Various other defenses may apply. This will depend on the facts of each individual filing, as well as state and local fraud laws. Also, lack of evidence is a frequently raised defense in many fraud claims.

How Is Health Care Fraud Detected?

Health care officials may be alerted to fraud through several indicators such as:

  • Inconsistent information on applications compared with previous medical records
  • Wrong information regarding credit cards, passwords, etc.
  • Reports from other persons indicating that a person is not really “disabled” or is otherwise unqualified for health care

In some cases, reports from other persons about a person not “appearing disabled” or in need of medical care may not be accepted. This is especially true for health care that is provided through government agencies and programs. However, private health care providers may accept this type of information when seeking to prove health care fraud.

Do I Need a Lawyer for Help with Health Care Fraud Laws?

Health care is a very expansive area of law that can cover many different types of violations. You may wish to contact a lawyer if you need help with any health care fraud laws or incidents. Your attorney can provide you with the latest information on fraud laws and inform you of your rights. If you need to attend any type of legal hearing, your lawyer can provide you with representation during the process.

Photo of page author Jose Rivera

, LegalMatch Legal Writer

Last Modified: 05-21-2014 11:13 AM PDT

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