Health care fraud indictments have been on the rise in Massachusetts since the enactment of the 2006 law requiring all residents to have health insurance . Federal prosecutors have been targeting physicians, medical providers and vendors who accept Medicare; and Medicaid fraud prosecutions are also on the rise. All health care providers are under scrutiny for billing practices, false reimbursements, and alleged kickbacks. If you have been swept up in this wave of prosecutions, contact our law offices.

Health Care Fraud

There are instances of consumers being prosecuted for fraud, including cases involving filing false claims, forging or altering bills, and receiving treatment by using someone else's medical coverage. However, h ealth care providers have been taking the brunt of the increase in prosecutions. The following types of provider fraud are most frequently involved in health care fraud charges:

  • Over Billing - submitting claims for services not performed, or submitting an invoice multiple times for the same services. This can also include overcharging patients for co-payment, or billing patients for services which were paid in full by a benefit plan
  • Upcoding - billing for a more costly service than the one actually performed
  • Upcoding Employee Work - billing at doctor rates when the work was actually performed by a nurse
  • Unbundling - using multiple billing codes instead of one billing code for a single procedure
  • False Diagnosis - involves falsifying a diagnosis in order to justify unnecessary tests or other procedures

Penalties

There are a wide variety of statutes which can be used to charge someone accused of health care fraud. Convictions under the Federal False Claims Act can result in up to five years in prison for each occurrence, with fines of $250,000 for individuals, or $500,000 for a corporation. The False Statements Act has punishments that include $10,000 fines and 5 years in prison for each violation. Other charges can include violations of the Social Security Act, wire fraud, mail fraud, obstruction of justice, and a variety of state charges.

Contact our Law Offices

If you have been charged with committing health care fraud or are currently under investigation, it is important to retain an attorney experienced with both state and federal charges. Contact a health care fraud lawyer in Boston today.

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