The American health care system is notoriously complicated, with billing going back and forth between patients, care providers, private insurers and government agencies. This complexity can lead to mistakes. It can also provide room for fraud.
Texas doctor indicted
Recently, a Texas eye doctor was indicted on multiple charges of fraud and money laundering. Prosecutors say the ophthalmologist deliberately misdiagnosed his patients and ordered excessive and unnecessary medical procedures in order to collect more than $13 million in payments through Medicare, Medicaid and other benefits programs.
The health care fraud charge alone could land the doctor in prison for 10 years.
Health care fraud in general
Phantom billing is a relatively common form of health care fraud in which health care providers bill insurers or government agencies for services that are unnecessary or that they never perform.
By some estimates, phantom billing and other fraudulent practices cost U.S. taxpayers more than $100 billion per year. In fact, some reports say the total may be much higher because state and federal governments don’t have enough agents to investigate every claim that looks suspicious.
Serious consequences
Even so, when prosecutors do pursue criminal charges involving health care fraud, the result can be extremely serious. The charges may be brought in federal court and convictions come with lengthy prison sentences and steep fines.
For professionals, a conviction also carries serious consequences for career and livelihood. They can suffer irreparable reputational harm and lose their professional licenses.
When the consequences are this serious, those accused typically can’t just pay a fine to make the problem go away. They have the right to a criminal defense, and they must build the most effective criminal defense they can.
