People often assume that those prosecuted for fraud have “earned” money by lying to others. Misconceptions about what constitutes fraud can sometimes lead to people making mistakes that put them at risk of criminal prosecution. The idea that one needs to directly profit from fraudulent acts to face legal consequences could endanger some professionals in the healthcare world. Health care fraud, particularly fraud involving insurance billing practices, is very common.
Billing specialists and other office workers might believe they have no personal risk of liability if a doctor or their supervisor tells them to unbundle charges or bill for an appointment that didn’t occur. However, people don’t need to directly make money to technically commit an act of healthcare fraud.
Anyone involved in health care fraud could face charges
If only the parties that directly profited from fraud faced criminal consequences, numerous parties with some degree of culpability would escape personal responsibility. Insurance billing fraud often helps increase company’s profit margins without necessarily leading to direct financial profit for the people doing the billing.
Regulatory authorities looking into possible health care fraud involving insurance billing practices will hold all employees to the same standards regardless of their role at the company. Someone who knowingly entered fraudulent charges or engaged in conduct like unbundling or upcharging to increase the company’s profits could end up accused of health care fraud.
A conviction or guilty plea could lead to someone’s future ineligibility for work in the healthcare industry, as well as a host of criminal penalties. Discussing company practices with an attorney and comparing them with federal rules might help office workers better determine whether they could be at risk of prosecution because of their employer’s billing practices.