Common Types of Healthcare Fraud in Florida (2024)

Healthcare fraud continues to be a significant legal issue within the US healthcare system, costing the federal government billions of dollars annually and undermining essential programs like Medicare and Medicaid. Knowing the most common types of healthcare fraud can help you avoid these unlawful practices. Consulting a federal criminal defense attorney in Miami can provide the necessary expertise to navigate these complex legal landscapes and defend your case effectively.

At The Law Offices of Barry M. Wax, we expert criminal defense lawyers. Serving Miami and beyond, we provide focused, effective representation. Call us now to schedule a case evaluation.

What Are the Most Common Types of Healthcare Fraud?

While every type of fraud is different in how the criminal act is executed, they all share the same goal. This is to unlawfully increase profits at the expense of other patients, providers and taxpayers.

Some of the most common examples of this include:

• Billing for services not provided: One of the most frequent examples of healthcare fraud is billing for services or procedures that never happened. This happens when a healthcare provider submits a claim to receive funds for a treatment that a patient never actually received. This can not only cause a significant financial loss for insurance companies and government healthcare programs but also inflate other healthcare costs across a health system.
• Upcoding: The fraudulent activity of upcoding is the practice of billing for a service that was more expensive than what was actually provided. For example, someone might bill for a comprehensive diagnostic evaluation when the patient only received their annual check-up. This distorts the actual cost of medical care which can drive up premiums for private insurance companies. If this happens, an investigation will try to see if it was an error or done on purpose.
• Kickback schemes: Whenever a healthcare provider receives an illegal payment or incentive in exchange for referring a patient to a specific service, this could be considered a kickback scheme. It is illegal to both offer and receive any type of compensation to refer a patient to a specific medical service, as it creates an environment where healthcare professionals suggest treatment that prioritizes financial incentives over what is actually the most effective patient care option.
• Unnecessary medical procedures: Another example of healthcare fraud is when someone performs a medical procedure that is not necessary for a patient’s condition. This happens when a healthcare professional performs a treatment or surgery that is not medically justified but still happens to make more money for the hospital. This introduces unnecessary risk to any patients who fall victim to this unlawful act of healthcare fraud.
• Falsifying patient records: It is illegal to falsify a patient record to try and support a fraudulent claim. The incentive for this illegal activity is to create an illusion that a procedure or test happened so that the individual requesting the funds can keep them all to themself. Not only is this behavior illegal, it is also dangerous.In the future, false patient records can mislead other healthcare providers to make treatment decisions based on inaccurate records, which could cause unnecessary damage.
• Prescription fraud: Another growing concern across the country is the increase in prescription fraud, especially in the era of the opioid crisis. This is when a healthcare provider prescribes a controlled substance, like a painkiller, without issuing an actual diagnosis for the treatment. The motive behind this is to obtain drugs that can be sold on the black market for profit.

Prescription fraud accusations are handled seriously, as they contribute to public health crises like addiction and overdoses.

While these are some of the most common instances of healthcare fraud in United States, the possibilities are not limited to this list. All of these examples attempt to profit at the expense of patients or public health. It can be scary to be accused of engaging in any of these crimes, but it’s important to remember that it does not automatically mean the accused is guilty. They have the right to hire a criminal defense attorney and make their case in court before a final verdict is made.

FAQs About Common Types of Healthcare Fraud in Florida

Who Is Most Targeted for Healthcare Fraud?

Government programs like Medicare and Medicaid are often targeted by individuals looking to fraud the healthcare system. It’s because these programs provide a large sum of money to those in need, which makes it an attractive target for those looking to unlawfully profit off of the system. Private insurance companies are another target, especially when a provider tries to inflate their reimbursements through false billing practices.

Who Commits the Most Healthcare Fraud?

Some of the most common individuals and organizations who commit healthcare fraud include healthcare providers, medical equipment suppliers, pharmaceutical companies, and sometimes even patients receiving care. Based on the varying levels of influence and access, these common culprits will manipulate the system to try and earn profits under the guise of delivering healthcare.

How Does Healthcare Fraud Affect Patients?

There are many different consequences for patients who become victims of healthcare fraud. This can include receiving an unnecessary procedure or medication that would cause a new health issue. It could also cause financial harm, as this repeated behavior can inflate healthcare costs and make everyone have to pay more out of pocket. Patients could also be denied coverage for legitimate care in the future if their insurance company previously supported a false claim.

How Can Healthcare Organizations Prevent Fraud?

Strong compliance programs that consist of regular audits is one of the top strategies for healthcare organizations to reduce instances of fraud across their organization. Educating staff on how to bill properly and spot irregularities can help. Additionally, implementing internal controls like electronic health record systems and billing software can be useful to flag potential discrepancies that need to be looked into.

Contact The Law Offices of Barry M. Wax Today

If you are under investigation for healthcare fraud charges, you need a strong defense lawyer on your side to help protect your interests and ensure no one takes advantage of your rights. Contact us today at Law Offices of Barry M. Wax to access a team of experienced and compassionate defense attorneys who have helped others facing similar charges in the past. We look forward to hearing from you and learning more about how we can help.