Understanding health care fraud

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.