Healthcare fraud can affect finances and licensing

The medical sector is often not what people think about when discussing fraud. Discussions about professional fraud often focus on the financial sector and adjacent industries, like real estate. Investment fraud and mortgage fraud are well-known white-collar crimes.

However, the healthcare industry sees a massive amount of fraud every year. The FBI estimates that healthcare fraud involves tens of billions of dollars in losses annually. Contrary to media representations of healthcare fraud, misconduct by individual patients is a relatively minor issue. Fraud committed by healthcare professionals accounts for the vast majority of losses in the healthcare sector each year.

Healthcare fraud can affect a professional’s licensing in addition to potentially triggering major criminal consequences. Professionals can even end up facing charges over decisions that may initially seem minor or harmless.

Healthcare fraud is often financial

Most cases of healthcare fraud do not actively harm patients because they simply involve misconduct during the billing process. A healthcare provider intentionally misrepresents the care that they provide or trains their billing staff to improperly handle reimbursement requests. They might separate charges or upgrade them to more expensive procedures whenever possible. While those may seem like victimless crimes, the cost of fraudulent billing passes on to policyholders or to taxpayers depending on the insurance program covering the patient. When federal authorities discovered billing fraud, everyone involved could face prosecution and potentially licensing penalties.

Some healthcare fraud actually harms patients

More serious scenarios of healthcare fraud might involve a physician ordering unnecessary treatment and tests in order to maximize what they can bill. Patients may suffer negative consequences when they receive unnecessary care or when they endure the stress of thinking they might have a health issue because the doctor orders frivolous extraneous tests.

Allegations of healthcare fraud can affect someone’s professional reputation and potentially their ability to continue practicing medicine in the future. Thankfully, a defense is possible. Those accused of fraudulent professional activity have the right to defend against those accusations in criminal court. They can also have a lawyer advocate for them at any disciplinary hearing conducted by state licensing authorities.

Responding assertively to fraud charges could help someone preserve their freedom, their reputation and their investment in their career. Those accused of healthcare fraud have a lot to lose if they do not respond to those accusations appropriately.