Direct profit isn’t necessary for health care fraud charges

Not everyone working in the healthcare sector earns generous, competitive wages. Some professionals earn typical salaries or even hourly wages because they work as support professionals, rather than as licensed medical caregivers. In theory, their jobs require less education and entail less risk than providing medical support to patients. However, those working in the front office of a medical practice or the billing department of a hospital can still be legally vulnerable.

In some cases, those professionals may have to perform tasks that violate federal law and put them at risk of fraud charges. People might assume that because they don’t make more money because of questionable billing practices they aren’t the ones at risk. Those just following instructions can still be vulnerable to prosecution in many cases.

Everyone involved in fraud is at risk

Insurance billing practices that constitute health care fraud can involve numerous different professionals. The medical professional seeing the patient, the coder reviewing the records of the appointments and the billing professionals submitting the invoices to the insurance company are all potentially at risk. So are any members of the practice’s management team who are aware of inappropriate billing practices.

Prosecutors do not have to prove that the people involved in a health care billing fraud scheme derived any direct benefit from that scheme to justify charges against them. A coder who makes $15 an hour could face many of the same penalties as a physician who alters the details of their medical notes to justify charging for more expensive procedures.

Various minor changes to billing records can potentially result in scrutiny by regulatory agencies and criminal prosecution. People accused face incarceration, fines, criminal records and even orders of restitution in some cases.

Those implicated in fraud schemes may sometimes be able to defend against those charges because they didn’t realize that there were alterations occurring behind the scenes. Other times, inappropriate training practices at the company might be the underlying reason why they failed to notice questionable billing practices.

Reviewing the state’s evidence and what happened at a hospital or medical office with a skilled legal team can help those accused of fraud related to medical billing evaluate different defense options. People don’t need to receive kickbacks or make six figures to be vulnerable to prosecution.