What are the Consequences for Healthcare Fraud?

Healthcare fraud, insurance fraud, Medicare or Medicaid fraud — these are all considered white-collar crimes and they all involve illegal gain through deception by consumers and healthcare providers. Due to the increase in the prevalence of these offenses, the federal government has begun to crack down on offenders, who face steep penalties if they are convicted.

What is healthcare fraud?

Under federal law it is a crime for healthcare providers to bill for services they did not perform or for products they did not provide. Knowingly performing services that are not medically necessary is also fraudulent. Other fraudulent activities include giving a false diagnosis in order to justify tests, surgeries and other unnecessary procedures, over-billing patients, and misrepresenting non-covered treatments as being medically necessary.

Consumers can commit healthcare fraud by allowing another person to use their insurance to receive medical services or using health benefits to pay for prescription drugs that were not prescribed by their doctor.

What are the penalties for insurance fraud in Pennsylvania?

Insurance fraud offenses are prosecuted as felonies, which in PA can be punishable by a prison term of up to seven years and fines of up to $25,000 for each count. This can add up quickly. If charged with a misdemeanor, the penalty is a prison term of up to five years and fines up to $10,000. In Pennsylvania, there are also civil penalties, in addition to the federal charges, of $5,000 for the first offense, and the court could order the accused person to pay restitution. Finally, the insurers who were harmed as a result of the insurance fraud can bring civil charges to recover damages, including the cost of the investigation, court fees and attorney fees.

For more information about the defense of healthcare fraud charges, contact a lawyer at the Law Offices of David Jay Glassman for advice and guidance. Call for an appointment in Philadelphia: 215-563-7100, or New Jersey: today.