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Healthcare Fraud Lawsuits

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What Is Healthcare Fraud?

Healthcare fraud involves the filing of false health care claims in order to obtain a profit or to reduce expenditures on health care costs. This type of fraud is quite widespread and may be accomplished by individuals or by entire entities attempting to avoid costs associated with healthcare coverage. Health care fraud is illegal and can lead to some very serious legal penalties.

Healthcare fraud is a broad category that covers many different types of fraud, including prescription drug fraud, Medicare fraud, insurance fraud, and other types of fraud. Most health care fraud violations involve the filing of false statements in relation to a health care application.

What Are Some Common Types of Health Care Fraud?

Healthcare fraud lawsuits may sometimes involve illegal conduct such as:

  • Filing duplicate claims- an applicant my file a duplicate claim, or a claim that is only slightly different, in order to reap dual benefits. They may then turn around and sell the additional medicine and equipment they receive
  • “Kickback” schemes: This is where the applicant is illegally rewarded for using or endorsing a particular type of medical treatment, drug, equipment, or service, or for providing illegal referrals
  • Fraudulent medical billing scams: For instance, overcharging or filing for excess services. Filing for unnecessary services is also illegal
  • Providing false information: Making false statements on a health care application or claim is generally considered a violation and can lead to both private and criminal consequences
  • Illegal resale: Selling medicines or equipments through a black medical market is very risky and can lead to legal consequences, as well as injuries to innocent persons

Due to these types of health care fraud, the health care industry is highly regulated and is subject to some very strict laws. Violating health care fraud laws can have far-reaching consequences for individuals and businesses. 

What Are Some Legal Penalties for Healthcare Fraud?

Legal penalties for healthcare fraud frequently involve the filing of criminal charges against the defendant. Many jurisdictions classify health care fraud as a type of white collar crime, punishable by criminal fees, and also by possible time in a county jail facility.  Multiple or repeat offenses can lead to more severe penalties.

In addition, some healthcare fraud claims can involve multiple parties, including multiple health care providers. Civil lawsuits can also be filed in connection with the fraud, especially if one health care company has suffered economic losses on account of the fraud.  In such cases, the liable parties may need to pay the plaintiff company a monetary damages award to reimburse them for the losses incurred due to the fraudulent claim(s).

How Can I Avoid Being a Victim of Health Care Fraud?

Health care fraud lawsuits can be avoided by taking some steps, such as:

  • Understand your rights- Hiring a lawyer can  help you to keep updated with any new developments in the area of health care law
  • Appoint a power of attorney- This will allow you to have a legal representative to help you with your health care claims in the event that you suddenly become incapacitated
  • Report health care fraud- The more authorities understand about this type of fraud, the more they can enforce anti-fraud measures

Do I Need a Lawyer for Help With a Healthcare Fraud Lawsuit?

Health care fraud lawsuits can be costly and may even involve an interaction with state criminal laws. If you need assistance with any health care issues, you may wish to speak with a lawyer immediately. Your attorney can assist you in filing a claim properly so that you avoid any violations involving fraud or deception. Also, in the event of a lawsuit, your attorney can help represent you in court as your case goes through the legal system.

Photo of page author Ken LaMance

, LegalMatch Law Library Managing Editor and Attorney at Law

Last Modified: 05-21-2014 11:14 AM PDT

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