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Health insurance fraud or health care fraud happens when people make financial gains by presenting false documents/papers to the health insurance company. They claim the insurance amount by submitting forged information. In the United States, sale of fake health insurance policies can also be termed as an example of health insurance fraud. Apart from this, presenting false bills or submitting medically unnecessary services or prescriptions and duplicate claims are also examples of such frauds. In the United States, FBI is the primary agency for probing into such cases. Some states consider such acts as felony. This article answers some of the most commonly asked questions on the subject and laws associated with them. Is it considered as a fraud if someone has two health insurances?
It is not a crime to have two separate health insurances. But, you should always mention both the primary and secondary insurance coverage while filling out applications. However, it could be considered as a fraud if you don’t disclose both the policies and try to place a claim on both for same kind of services. It might lead to the termination of both of your policies. How does health fraud happen?
Apart from above mentioned examples, there is also a different type of fraud related to health care which is a matter of concern. It is a deceptive sale or advertising products that the manufacturers claim to be effective and beneficial for consumers’ health. One important point to be noted here that the manufacturers try to push those products like breast and pennies enhancement lotions and weight loss/gain pills without procuring certificate from an authorized medical body. By the time the consumer gets to know about the fraud after buying any of those products, the company would have already disappeared. If you feel that you have been duped by such companies, it is highly advisable to retain the services of a criminal lawyer who could legally assist you. How to report about a health care insurance fraud?
If you suspect that someone is appropriating health care insurance amount by submitting phantom claims for services or supplies that were never provided, you can alert the insurance company’s fraud section about it. This apart, you can also get in touch with organizations including FBI, Department of Health and Human Services, Office of the Personnel Management, The U.S. Postal Service, Federal Trade Commission, National Health Care and Anti-Fraud Association and Coalition Against Insurance Fraud to report these acts. What are the punishments for crimes related to health insurance fraud?
In the United States, this type of crime is considered as a felony and the punishment for such crime can range from a jail term of from 1 year to 20 years. This depends on the severity of the crime and the value of the fraud committed. Punishment also varies from state to state as per its respective laws. You should get in touch with a criminal lawyer to know more about this issue. What are the penalties for health insurance fraud?
This felony can attract fine of up to $15,000 per penalty during the trial process. In addition to this, federal court can impose an additional fine to the tune of $1 million which depends on the circumstances which could led to the fraud. As the law pertaining to such crimes varies from state to state, one might face many problems while dealing with such issues. If you have any questions related this matter, you can always ask a criminal lawyer to help you in this.
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