Healthcare Fraud Defense Attorney
in Fort Myers

Billing for services not rendered

Medical care providers and facilities sometimes submit documentation to government agencies and insurance companies claiming services they never provided. This practice is known as phantom billing. Investigators verify these claims by comparing patient records. If the service is missing from the corresponding patient’s record, the government or insurance provider may investigate further for evidence of fraud. In some cases, a patient entry may be missing due to a legitimate error. However, multiple missing entries across several patient profiles and multiple dates further indicate the possibility of fraud.

Misrepresenting service dates

For patients who receive multiple services on the same day, a medical care provider may separate the services across multiple dates. This practice is known as unbundling. Each office visit is considered a separate billable service. Therefore, medical care providers are sometimes motivated to fraudulently bill the insurance provider for separate visits in the interest of receiving additional payments.

Misrepresenting the service provider

Insurance companies often compensate service providers based on the credentials and education level attained by the staff member who delivered the service. Some medical care providers may bill for a service provided by a licensed physician or senior staff member although the service may have been actually performed by a nurse, a physician assistant, or another staff member who may be qualified to perform the service even though he or she does not have the credentials listed in the insurance claim.

Kickback schemes

Medical providers are prohibited from paying for patient referrals. Conversely, healthcare providers are also prohibited from receiving payment for a patient referral. To establish a kickback scheme, prosecutors must prove the payment was made in exchange for the patient referral. Providing this type of case can be difficult because the transactions are often disguised as legitimate sales of equipment and other items and services of value. Kickback schemes can be especially problematic when patients are referred for services they do not need.

Healthcare fraud committed by individuals

Consumers may be the direct victims of healthcare fraud in some cases. Along with insurance marketing and open enrollment announcements in the U.S., fraudsters also market fake healthcare plans. These schemes are often vehicles through which identity thieves capture victims’ personal information, which can later be used to engage in other criminal activities like credit card fraud.

Identity swapping

It is illegal for individuals to swap identities or to allow someone else to use their insurance card or receive health services in their name. This practice typically involved someone who is insured allowing a family member or someone else to visit a healthcare provider by using the insured party’s identity. In other cases, an individual may actually receive covered services under someone else’s name as part of an identity theft scheme.

Impersonating a healthcare provider

In some cases, an individual may pretend to be a credentialed healthcare provider in the interest of collecting payment for services. These cases may involve cosmetic procedures or standard medical care services. Individuals also sometimes pose as licensed medical care providers to bill insurance companies for the purchase of medical equipment.

Prescription fraud in Fort Myers

Florida was once a notorious hotbed for doctor shopping, the practice of visiting multiple clinics to amass large quantities of restricted prescription painkillers. Prescription fraud still happens today in different forms, and it is classified as a type of healthcare fraud. Individuals who are looking to obtain prescription drugs for habitual use or sale sometimes steal prescription pads and forge prescriptions. They may know a medical care provider or pharmacist who also participates in the fraudulent activity. Individuals who have legitimate prescriptions for commonly-abused drugs may engage in a fraudulent practice known as diverting. Selling legally-obtained prescription medication is a common form of diverting. Doctor shopping also still occurs today.

Not only are individuals who engage in fraudulent activities to obtain prescriptions at risk of facing state and federal charges, but law enforcement places an even greater focus on medical care facilities and industry insiders who participate in prescription fraud schemes. Doctors who knowingly write prescriptions to members and associates of prescription drug rings, pharmacists who intentionally supply drugs to fraudsters, and medical care professionals who engage in theft can be convicted of state and federal felony offenses and sentenced to years in prison.

Healthcare fraud lawyer in Fort Myers

Healthcare fraud schemes are often complex, and they may involve players who are unaware they are participating in illegal activity. Medical care providers and individuals who are under investigation for fraud should immediately contact a Fort Myers healthcare fraud defense attorney. Our law firm will carefully examine your case and help you make informed decisions regarding your next steps.

Reach us today to receive a free, complimentary case evaluation. We value your privacy, and we prioritize the protection of your professional reputation. Call us today for immediate, discrete service.