Common Types of Health Care Fraud in New York (2024)

Healthcare practitioners have enough to worry about on a day-to-day basis without also having to be concerned about potential charges for fraud. Healthcare professionals have a responsibility to be wholly accurate in their healthcare claims to avoid a fraud investigation, particularly when it comes to billing patients and sending claims to government healthcare agencies like Medicaid or Medicare. Knowing the common types of healthcare fraud in New York can be a good start.

What Is Healthcare Fraud?

Healthcare fraud occurs when someone intentionally deceives a part of the healthcare system for their own gain, usually financial. Healthcare fraud can be committed by doctors, nurses, patients, insurance carriers, and other medical providers. It’s largely based around intent and attempting to claim unearned or undeserved profit from the healthcare industry. If a medical practitioner is charged with or even accused of fraud, it can be damaging to their reputation.

If you are accused of defrauding the healthcare system in New York, you should reach out to an experienced healthcare fraud defense lawyer who can assist you in building a strong defense and figuring out your next steps. If convicted, you could face serious charges, particularly if you are convicted of healthcare fraud in the first or second degree, both of which result in felony charges.

Common Types of Healthcare Fraud in New York

Any attempt to defraud a healthcare provider or insurance company, cheat a government-funded healthcare program, or manipulate the state of New York’s healthcare system can result in charges of healthcare fraud. The penalties you may endure will depend entirely on the nature of the offense and the severity of the charges made against you. Here are some of the most commonly reported types of healthcare fraud that occur in New York:

• Fraudulent Organizations: It is not uncommon for individuals and business entities alike to establish fraudulent businesses and organizations that are actually fronts developed for the sole purpose of siphoning funds from Medicare, Medicaid, and other healthcare agencies in the state. These businesses usually only exist on paper and are considered fraudulent.
• Improper Billing: One of the more common forms of healthcare fraud occurs when healthcare organizations and providers bill their patients and clients for services that they did not actually provide. Those services are, however, covered by Medicare, Medicaid, and other healthcare funding systems.
• Illegal Drug Sales: Doctors with the ability to prescribe medication are legally bound to only prescribe medications that fall under the standard of care that their patients require. When a doctor charges certain premiums for specific prescriptions or sells people prescription drugs illegally and without a legitimate medical need for them, they can be found guilty of defrauding the healthcare system for their own benefit.
• Double Billing: Some healthcare providers and organizations double bill their services to various healthcare programs to get paid multiple times for the same service, with the extra money often going into somebody’s pocket. This practice is also known as “double dipping” and can go on for years without anyone noticing a discrepancy.

FAQs

What Are the Most Common Types of Healthcare Fraud?

There are many different kinds of healthcare fraud, but most of them involve defrauding the healthcare system for money. Some of the most common healthcare fraud practices involve billing healthcare providers for services that did not actually happen, billing for a more expensive service than the one that the patient actually received, receiving money from healthcare companies seeking to generate business, and double billing for the same service.

What Is an Example of a False Claims Act in Healthcare?

The False Claims Act was put into action in order to prevent the federal government from being charged fraudulently, incorrectly, or inappropriately for healthcare goods and services provided. An example of a false claims act in the healthcare system would be if a patient or business entity was billed for a procedure that did not occur. Knowingly participating in such fraudulent activity is also a violation of the act and could result in severe penalties.

What Is the Most Common Type of Medicare Abuse?

There are many different types of Medicare abuse that occur all the time by doctors and patients alike. Regardless of who commits the offense, Medicare abuse is still considered healthcare fraud. One of the most common types of Medicare abuse is improper medical billing.

This can be an act such as billing a patient for a procedure that didn’t actually happen or double billing their services to certain healthcare programs or even knowingly overcharging patients.

What Unethical Behaviors Would Be Considered Healthcare Fraud?

It is important to always expect a certain degree of ethical behavior from healthcare professionals. When they commit unethical behaviors, they put their reputations and careers at risk. If that behavior is fraudulent, they may also risk facing criminal charges. The following unethical behaviors could also be considered healthcare fraud:

• Falsifying a patient’s records and adding services they did not receive.
• Prescribing patients unnecessary medications or performing unneeded surgeries.
• Billing insurance companies for treatments that were never given.
• Lying on insurance claims.

Reach Out to a Healthcare Fraud Defense Lawyer Today

Dealing with a case of healthcare fraud can be infuriating. Healthcare is such a complex and fragile world that trying to navigate your case on your own may only result in substantial losses for you. Having an experienced healthcare fraud defense lawyer on your side who understands what’s at stake for you and is ready to provide assistance can really make all the difference.

The legal team at The Vitaliano Law Firm understands the specific kind of legal support you are going to need while dealing with a case such as this. Contact our firm to speak with a valued team member and schedule a consultation to go over the details of your case.