Orlando Federal Healthcare Fraud Lawyer

Types of Federal Healthcare Fraud

Federal law defines a healthcare fraudster as someone who “knowingly, and willfully executes or attempts to execute a scheme…to defraud any healthcare benefit program or to obtain by means of false or fraudulent pretenses, representations, or promises any of the money or property owned by…any healthcare benefit program.” Some specific types of healthcare fraud include:

• Incorrect CPT Codes: Some providers intentionally use the wrong Current Procedural Terminology codes to increase their reimbursements. But in many situations, the miscoding is an error. Not all medical procedures have accompanying CPT codes, so providers must use their best guesses. When they do so, they usually give themselves the benefit of the doubt.
• False Medical Records: This form of healthcare fraud is almost as common. As is the case with errant CPT codes, the intent element is often missing here. Most doctors reconstruct at least part of their charts from memory. Additionally, when these charts go to records clerks, information often gets lost in translation.
• Unnecessary Services: Occasionally, doctors provide services that are clearly unnecessary. Other times, however, doctors are overly-cautious, so they perform tests and other procedures which might not be necessary as far as prosecutors are concerned. This behavior is especially common in jurisdictions, like Florida, which have high medical malpractice litigation rates.

Other healthcare fraud cases include charging for services not provided and falsifying patient treatment and medical histories to support controversial charges.