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What Are The Potential Penalties For Health Care Fraud And Abuse

Asking the doctor to issue two invoices to get reimbursement of the total amount of the consultation with the health plan or doctors who direct the brand of a particular product to earn commission from a manufacturer are common practices, but constitute a crime. However, these crimes, done by patients, suppliers of drug-medical-hospital materials or even by doctors themselves, only cause harm to consumers, often times leading to the need to hire a health care lawyer. The frauds committed against the health plans, which often only benefit the practitioner itself, further make plans cost more to the beneficiaries.

Omission of diseases

Fraud can start already in the completion of the questionnaire of the plan, when the consumer decides to omit a pre-existing disease. Fraud occurs when people know about the disease, but it omits. People act against the law and believe nothing will really happen to them. This might seem fine, but those who do it often need the help of a Health care fraud attorney to get rid of the issue.

Using someone else’s health plan

When the beneficiary allows another person to use his social security number or any other sort of documentation and see a doctor. Allowing someone to take advantage of the plan is fraud. For this reason, many doctors’ offices and laboratories ask for the original document and photo before carrying out a procedure. In this case, there are two crimes: presentation of false documents and false identity. Click here.

Two receipts for a single appointment

It is common in a doctor’s office to request two receipts, with different dates (separated by more than 60 days, for example), but related to a single consultation or procedure performed. The behavior is very common in the modality “free choice” of professionals, marketed by some plans. In this category, the plan has a limit value per consultation, but in general, it is below the price that some doctors charge when attending private patients. There is an agreement between the operator and the tax authorities, this difference between notes can be traced , leading the need to hire a Health care fraud attorney.

Families create companies to have a business plan

There are increasing cases of families that open up front companies only to achieve adherence to a corporate plan. The modality is cheaper when compared to the collective or individual plans. However, besides being a prohibited maneuver, it is important to warn that the plan could be more expensive in the long term. This is because, if one of the beneficiaries or their dependents face any serious health problem, the monthly fee may increase dramatically, since the group has a small number of people.

Change to higher value of reimbursement receipt

 In this case, the professional asks if the patient wants a receipt with a value higher than the value of the consultation, in this way the beneficiary receives a refund amount greater than the amount paid. The practice, totally illicit, affects daily health plans, which end up having higher expenses and, consequently, the costs with tuition increases. The doctor who is convenient with this practice may have to pay more taxes because there will be divergence in the income tax return. Both patient and clinic might need to get a Health care fraud attorney to sort the situation out. To find out more, check out https://federal-lawyer.com/healthcare-defense/

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