Healthcare Fraud

A Rolling Meadows Health Care Fraud Attorney With The Experience To Defend Your Charges

Health care fraud is a multi-million dollar problem that influences the future of many Americans each year. Health care fraud is classified as the intentional submission of false or misleading information by a provider or consumer in order to determine the amount of health care benefits that should be paid or in order to turn a profit. With health spending increasing 6% annually, it is not surprising that the rate of health care fraud also is increasing.

Health care fraud can be conducted by not only the provider but also the practitioner and the patient in a number of ways. Below are some of the most common examples.

Practitioner health care fraud schemes:

  • Billing the patient’s insurance for services that were not given or for services that are not covered by insurance,
  • Prescribing unneeded medication to a patient for additional or unnecessary treatment or performing unnecessary procedures for purposes of generating payments,
  • Waiving co-pays and deductibles,
  • Modifying patient medical records, changing dates of visits or procedures, misidentifying members or providers,
  • Accepting kickbacks or bribes for prescribing certain medicine, and
  • Using unlicensed staff members.

Patient health care fraud schemes:

  • Intentionally falsifying information when applying for services,
  • Obtaining a prescription in order to sell it on the black market, and
  • Forging insurance information in order to get coverage.

How Are Those Accused of Health Care Fraud Caught? What Are The Penalties?

Some of these schemes are much more common than others, such as the unnecessary treatment or procedures for those individuals with certain conditions that can require diagnostic testing or those individuals who are convinced they need rehabilitation for an addiction that may be treated in a number of different ways. Most health care fraud schemes committed against the patient can be caught by looking at your Explanation of Benefits and comparing it against a personal log you keep of your visits.

While some people can make an honest mistake, including both the practitioner and the patient, when it can be proven that a party is purposefully defrauding the system, serious punishment results. When committing fraud, there is an acknowledgment that the party intentionally did something wrong in order to gain from it. Punishment for these crimes varies but includes prison time, fines, restitution, and probation. Depending on the nature of the act and any resulting injury, a party can serve up to a decade for each offense committed. Specifically, if serious bodily injury results, a person can be fined and imprisoned up to 20 years. Under federal law, anyone attempting to or knowingly and willfully executes a plan to defraud the health care system with the intent to financially benefit is punishable. 18 USC 1347.  State laws vary and Illinois has a cumbersome statute that lays out the specifics of what qualifies and the potential punishment, ranging from a $300 fine to a felony conviction. 720 ILCS 5/17-10.5. Additionally, Congress has established a coordinated Fraud and Abuse Control Program, aimed at linking efforts on the local level with those federal efforts to take down those responsible for these fraudulent programs.

Why You Need a Qualified Illinois Health Care Fraud Attorney on Your Side

Health care fraud is a serious crime with severe penalties.  If you or someone you know has been accused of health care fraud, whether it is medical identity theft or inappropriate billing procedures, you deserve a strong defense.  Do not hesitate to contact the Offices of Sami Azhari, LLC, any time, day or night, weekday or weekend, to discuss your case. Feel free to call Sami directly at (312) 626 – 2871 or (847) 255 – 2100. No commitment is required and the consultation is always free.