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Investigators take medical fraud seriously

Because medical insurance is a complex and complicated entity, some people working in the health care industry have found it easy to deceive the system for personal gain. Patients are often unaware of the coverage their plans offer or the types of diagnostics a physician may order for particular complaints. Add to that the level of trust many place in their health care providers, and you can see why someone could find fraud enticing.

However, you may have been shocked to have received word that investigators are examining you and the role they believe you played in the scheme to defraud patients in your office. Whether you are completely innocent or caught up in a ring of deceit and theft, you can't pretend it will go away. Detectives are focused on the serious risks patients face in the midst of health care fraud.

The patient pays for medical fraud

Health care embezzlement can take many forms. For example, someone in your medical office may falsify the records of a patient in order to bill the patient or insurance company for unnecessary services. It is possible that someone has used the identity of your patients to bill Medicaid or other insurance companies for tests or procedures the patient never received. While you may think that these crimes don't really hurt anyone, health care fraud may endanger a patient's health or safety in any of the following ways:

  • Unnecessary tests or procedures may jeopardize the health of a patient.
  • False claims may exhaust a patient's lifetime health insurance benefits.
  • Falsified medical records may cause a physician to order inappropriate medical treatment.
  • Patients may fail medical exams for jobs or life insurance because of falsified medical records.

    Aside from the human cost, some agencies estimate that medical fraud costs consumers tens of billions of dollars, resulting in higher insurance premiums, more out-of-pocket expenses and fewer benefits.

    Should I be worried?

    As more cases of medical fraud come to light, the federal government reviews its policies, tightens its laws and toughens its penalties. This may make things difficult for you. It may not be enough to have just any attorney on your side.

    The vital difference for you may be to have an attorney with experience in federal courts. Since federal investigators were likely on the case long before you even suspected you were under investigation, time may be of the essence. Having a skilled advocate means you have someone protecting your rights and working for the best resolution for your circumstances.

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