Why Do Doctors Commit Healthcare Fraud?

doctor holding clipboard

Many people think of healthcare fraud as the fraudulent use of health insurance to cover medical expenses. While that is a common example, healthcare providers can also commit healthcare fraud. The consequences of a healthcare fraud conviction are serious and can impact the professional future of physicians, nurses, pharmacists, and all other providers. If you are being charged with healthcare fraud, contact Levine & Levine Attorneys at Law today.

Types of Medical Provider Healthcare Fraud

There are numerous strategies that have been used to commit healthcare fraud, unbeknownst to the patient.

  • Double billing: this occurs when the physician submits multiple insurance claims for the same service.
  • Phantom billing: when the physician bills for services never rendered.
  • Upcharging: physicians may bill for a service that is more expensive than what the patient actually received.
  • Kickbacks: this may occur between different healthcare providers if one offers the other money or other benefits in exchange for patient referrals.
  • Giving unnecessary tests and treatments: providers may conduct unnecessary examinations or prescribe unnecessary treatments in order to make more money.
  • Waiving copays: if the doctor waives a patient’s copay and instead bill the insurance company to make up the difference, this is healthcare fraud.

Motivations for Committing Healthcare Fraud

The main motivation that healthcare providers have for committing fraud is financial gain. By increasing the number of tests, treatments, and other services on the bill, they can collect more money from the insurance companies.

Other times, however, providers may commit fraud out of the goodness of their hearts. When patients come in needing medical care but cannot afford the out-of-pocket costs, healthcare providers may try to lessen their financial burden by overbilling insurance companies. While this is done with good intentions, it is still a fraud crime.

Penalties for Healthcare Fraud

Healthcare fraud can be both a state and federal crime. Typically, the FBI and private insurance agencies investigate instances of suspected healthcare fraud.

The potential penalties vary based on the types of fraud committed and the level of severity. In general, a healthcare provider convicted of committing healthcare fraud faces:

  • Up to five years in prison
  • Hundreds of thousands of dollars in fines
  • Probation
  • Additional civil fines or restitution
  • Loss of their license to practice

Kalamazoo Healthcare Fraud Defense

If you are a healthcare professional who has been accused of committing fraud, contact our team at Levine & Levine Attorneys at Law. We have helped many professionals fight their fraud charges, and we want to help you protect your career and future in healthcare.