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Understanding health care fraud

On Behalf of | Aug 2, 2021 | Criminal Defense

Both medical providers and patients in Illinois can be charged with health care fraud. People who provide health care services without proper licensing can also be charged with this white-collar crime.

What is health care fraud?

Any act that intentionally defrauds the health care system could be classified as this type of white-collar crime. Receiving unlawful health care payments or benefits, whether as a patient or a medical provider, is considered health care fraud. Some examples of health care fraud include:

  • Creating or using forged prescriptions
  • Doctor shopping to obtain controlled substances
  • Fraudulent billing of health insurance
  • Impersonating a doctor
  • Using another patient’s legal prescription
  • Using another person’s health insurance

Who investigates health care fraud?

The primary agency that investigates health care fraud is the FBI, though other state and local agencies are often involved in these investigations. Health insurance groups such as the National Insurance Crime Bureau also investigate suspected incidents of health care fraud.

Prescription medication abuse

A large number of health care fraud investigations center around prescription medication abuse. Because some prescription medications can be so addictive, the illegal distribution of these drugs is a huge problem. To avoid suspicion of health care fraud, it is important to be careful with prescription drugs, especially pain medicines like opioids. Here are some of the best practices to follow when you are taking a prescription medication:

  • Follow your prescription instructions exactly.
  • Never share your medication.
  • Turn in unused or expired pills.
  • Wean yourself off of opioids as soon as possible.

What should you do if you are charged with health care fraud?

If you become aware that you are being investigated for health care fraud, you may want to start your own investigation into why it is so. It may then be important for you to begin documenting and saving all evidence that could aid in your defense.