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What Is Healthcare Fraud?

Fraud is using deceit or misrepresentation to gain money, goods or items of value. While certain healthcare fraud crimes involve healthcare providers, others involve patients and clients. Regardless of whether you are patient or provider, a fraud conviction has serious penalties. You could face costly fines and significant incarceration time. You may even be prosecuted on the federal level.

Examples of healthcare fraud

According to the Federal Bureau of Investigation (FBI) healthcare fraud costs the United States approximately 80 billion dollars a year. In some cases, the line between legal and illegal may be blurred – or you may not be aware that what you are doing is illegal.

Common examples of healthcare fraud include:

  • Double billing – This occurs when you charge twice for a single service, product or treatment.
  • False billing – In some fraud cases, the healthcare provider bills for a more costly service than the one provided. While subtle at first, this type of behavior becomes easily detectable over time.
  • Kickbacks – A kickback is when a healthcare provider intentionally accepts payments, products, or services for the purposes of soliciting a healthcare program or business.
  • Phantom billing – Phantom billing is charging for tests not performed.

Those convicted of federal healthcare fraud could spend decades or even a lifetime behind bars. In April of 2013, in Texas, a federal jury convicted three people in a healthcare fraud scheme stemming from their involvement in the operation of Euless Healthcare Corp. The punishments each defendant received were serious, amounting to many years of prison time and excessive fines. If you face fraud charges, a San Antonio criminal defense attorney can help protect your interests.


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