False Claims
  ·Health Care Fraud

What is health care fraud?

Health care fraud is the misrepresentation of health care transactions by any party, including health care providers, employer groups, or health care plan members. Health care fraud typically involves billing for services not rendered, double billing, and submitting improper cost reports. Currently, it is estimated that health care fraud costs Americans approximately $100 billion per year. These massive losses are one reason Americans are so disgruntled with the current health care system.

How does health care fraud affect me?

Health care fraud affects everyone. Due to the amount of money lost every year to fraudulent claims, the cost of health care is rising. This means that employers must pay higher health insurance premiums and that members must pay more for health care benefits. Due to this cost increase, many people are not able to obtain the affordable health care that they want or need.

What happens to someone who commits health care fraud?

Individuals convicted of this crime face imprisonment and substantial fines. Numerous state and federal laws and regulations exist that penalize, fine, and sanction individuals or groups engaged in health care fraud. The consequences for committing fraud include a mandatory exclusion from Medicare and Medicaid, and offenders are often required to pay very high monetary penalties.

What are the most common types of health care fraud?

· Provider Fraud: Typical provider fraud involves improper billing, the performance of unnecessary medical services, and the misrepresentation of information.

· Member Fraud: Typical member fraud involves using someone else's coverage, filing false claims, or misrepresenting bills, invoices and receipts.

· Employer Fraud: Typical employer fraud involves the false representation of an employer group, the enrollment of ineligible individuals, and the falsification of important dates and information.

What can I do to avoid health care fraud?

The most important thing you can do is stay informed. Ask your health care provider questions. Keep records of all your statements and transactions. Be careful when you disclose your insurance information. Almost every health care plan has a customer service department set up to answer your questions on any subject. Take advantage of this service.

If you are aware of individuals or entities involved in health care fraud, you may be entitled to a reward under the False Claims Act. To have an attorney answer your questions about health care fraud or the False Claims Act, please contact The Schofner Law Firm.