Health care fraud is a prevalent issue in the United States and is estimated to cost the country more than $68 billion every year. That equates to approximately three percent of all annual healthcare spending in the US.
The financial cost of health care fraud is high, and there are additional repercussions from this type of crime that can be observed within medical environments.
What is Health Care Fraud?
Health care fraud will take many forms and can be perpetrated by people at all levels of the health and insurance sectors, as well as by patients themselves.
Common acts of fraud by patients include obtaining false sickness certificates, prescription fraud, providing false information to make an insurance claim, and evading their medical charges.
Common acts of fraud by doctors and other medical professionals include claiming for tests and procedures that have not been undertaken, prescription fraud, and prescribing treatments that are not necessary so that they can claim the insurance money.
Contractors within the health care sector are also known to commit fraudulent acts, such as overcharging for services or making false insurance claims for unused services.
For further details, check out this official site for more information about health care fraud.
The Legal Consequences of Health Care Fraud
The legal consequences for committing this crime vary from state to state, and there are both civil and criminal penalties for making a fraudulent claim. The decision to prosecute in civil or criminal court will depend on an individual case’s specific nature.
When a civil penalty arises from health care fraud, the accused will likely be given a fine to pay.
In the event of a criminal prosecution, the accused may land themselves in prison, have to pay a large fine, pay back the amount of money that they fraudulently claimed, or be put on probation.
Prison terms for this crime can be very severe, often amounting to ten years in prison for each separate offense. Fines for criminal prosecution of this crime can amount to $500,000 per offense. Failure to pay a fine could result in further legal action.
The True Cost of Fraud
This type of fraud can have a profound impact on the health care system. It can be a serious drain upon resources and increase costs across the board.
Corruption and fraud within the United States’ health network is one of the biggest threats to the sector and is being fought against in a number of ways.
When doctors order unnecessary tests and treatments for patients to claim the insurance money, they contribute to overburdening the system. This can take valuable resources away from those who truly need them and cause overcrowding in hospitals and other health care facilities.
Through harsh sentences for this crime, the country is fighting back against health care fraud. This helps to ensure that resources continue to be allocated fairly and that criminals do not profit from exploiting the health care system.