Medical billing fraud can easily seem like a conspiracy to investigators and criminal courts. It is all too easy for those who investigate and prosecute cases to assume misconduct or malicious intent when the trust is that someone didn’t understand the consequences of their actions.
When a new billing specialist starts at a medical office, they want to keep their job and help their employer make as much money as possible. In some cases, that new worker receives training to unbundle certain services and bill for them separately or to otherwise engage in fraudulent billing practices. Other times, they may know better than to perform such actions themselves, but they see it happening and say nothing.
Prosecutors may eventually implicate numerous people in a healthcare fraud scheme. Such situations will often lead to federal charges, especially if there are any questionable charges submitted to Medicaid or Medicare by the medical practices in question. Everyone from the head of the billing department to the individuals entering the charges or even the doctor submitting the medical records could face criminal charges because of the company’s billing practices.
You don’t have to make money off of the fraud to face accusations
You may assume that so long as you are just following direct instructions or minding your own business, you won’t have any criminal liability for the company’s actions, but you may be wrong. Although you don’t make money off of the fraud, it does benefit you.
Whether you make a direct profit off of the billing practices employed at the company or not, you will benefit indirectly through your employment. Anyone involved in the billing process or aware of how the company alters the charges it enters or creates false charges will potentially be at risk of serious federal charges.
Financial crimes often require a complex defense strategy
You may feel blindsided when you end up charged with a crime when all you did was adhere to the training provided by your employer or follow your manager’s instructions. Many defendants facing allegations of white-collar criminal offenses related to health insurance fraud will need to carefully review the financial records that comprise the evidence against them and explore their various options for mounting an aggressive defense.
Recognizing the need to respond assertively to health care fraud criminal charges can potentially make the difference between conviction and acquittal.