Medical professionals often find that generating adequate revenue to keep a private practice solvent is difficult. Especially when a professional has started their own medical practice, they may have a difficult time generating the necessary revenue to pay for equipment, facilities and support staff wages.
Creative billing practices may sometimes seem like a viable solution for those trying to operate successful independent medical practices. Unfortunately, tactics like unbundling discounted charges or upcoding minor procedures can lead to allegations of health care fraud or health insurance fraud. Such allegations can lead to a host of potential consequences, including federal prosecution in some cases.
Incarceration
White-collar criminal offenses do not necessarily cause physical harm to individuals. However, they can cause financial damage to people, businesses and the government. When the courts hear cases related to health care fraud, they can impose a variety of criminal penalties. Incarceration is a common choice, particularly in cases where the total value of the fraud is six figures or above.
Fines and restitution
Financial penalties are standard in cases involving insurance fraud. The medical professional or business owner implicated in a health insurance fraud scheme could face fines imposed as part of a criminal penalty. Additionally, the courts often order those who profited from improper billing practices to reimburse the affected parties. The greater the scope of the fraudulent billing activity, the bigger the financial burden that the courts may impose on a defendant after they enter a guilty plea or get convicted at trial.
Licensing penalties
Practicing medicine requires a state-issued license. Medical licensing boards typically look at an individual’s criminal record as well as their professional and educational background when deciding whether to renew or issue a license. Professionals convicted of financial fraud could lose their license. They may also be unable to renew or regain the license they use for their profession in the future.
There are many different ways to respond to allegations of healthcare fraud. The unique details of the situation influence which strategies may work. From negotiating a plea to a lesser charge to proving that a professional was unaware of fraudulent billing activity, there are many ways avoid the worst-case scenario in situations involving alleged health insurance fraud.
Reviewing the state’s evidence with a skilled legal team can be an important starting point for those facing health care fraud charges. Medical professionals need to think about the long-term consequences of their choices before they respond to allegations of fraudulent billing activity.