At the start of the pandemic, multiple government agencies, including the FBI, warned of the potential threat of health care fraud. From fake COVID-19 testing kits to miracle treatments, there are several ways that a healthcare provider can exploit a crisis and falsely charge patients for treatment or overcharge insurance companies for coverage. However, the healthcare industry is extremely complicated, especially in a state as large as California; and while fraud may be rampant, many healthcare professionals may inadvertently end up on the wrong side of the law for an honest mistake.
Why Investigators Are on High Alert
Roughly a month into the Stay at Home Order in California, the FBI released a statement warning consumers of potential healthcare scams in the forms of fake COVID-19 tests and fake COVID-19 treatments. The testing schemes often involved scammers calling someone, emailing them, or going door-to-door to sell testing kits or perform unapproved and often fake tests for the coronavirus. These individuals would often ask for medical insurance information and social security numbers in order to bill their insurance companies and pocket the proceeds.
With regard to the treatments, the FBI also discussed similar strategies scammers used to sell fake COVID-19 cures and warned consumers against sharing their medical information with anyone other than a medical professional. These fears are also supported by the U.S. Food and Drug Administration (FDA), which has outlined several fraudulent COVID-19 testing kits and treatments that were being sold and administered by unlicensed scammers. Both agencies reminded consumers that there is no cure or vaccine available yet for COVID-19 and all treatment should be administrated by a licensed medical professional in a controlled medical environment like a hospital, not someone’s home.
Avoiding Healthcare Fraud Charges
Healthcare fraud is a very real danger in our society, especially as our elderly population grows. Older adults are often not aware of common telemarketing, email, or door-to-door scams, which is why they are often the target of fraudulent crimes like credit card fraud or mail fraud. That being said, not every case of healthcare fraud is legitimate, and it is possible for innocent medical professionals to be charged with a crime because of simple billing or filing errors.
No one wants to be caught on the wrong side of a healthcare fraud charge, especially given how zealously federal agencies and insurance companies will investigate these cases. Without a proper defense, you may face imprisonment in a county jail or state prison and between $1,000 and $50,000 in fines. These charges are largely based on how much money was allegedly stolen, but you can also lose your license and be barred from practicing medicine.
To protect yourself from these consequences, you will want to take several steps to ensure you do inadvertently commit healthcare fraud. While we are well into the pandemic, hospitals, doctors, and nurses should not become lax in their filing and billing procedures. Whenever you get a new patient, whether or not they have the coronavirus, make sure to follow all standard intake procedures and ensure that no file is lost. Healthcare fraud charges can be filed simply for filing multiple claims for the same treatment, which can easily occur if a staff member is overworked and accidentally duplicates a claim. If you are unsure about a claim, check with the insurance company or other staff to ensure it was not already submitted.
Hospital administrators should also abide by all new procedures outlined by the Centers for Disease Control and Prevention (CDC) and other medical agencies. The COVID-19 pandemic is a unique situation few hospitals have had to deal with, but there are guidelines about sanitary guidelines, how to proceed with an influx of patients, and testing procedures. Make sure all treatments and tests are properly filed to the right patient so that staff members do not inadvertently file a claim twice or file a false claim for a patient who never received treatment.
If you do end up on the wrong end of an investigation, keep calm and contact an Orange County fraud defense lawyer immediately. The legal team at Law Office of Michael L. Guisti can begin preparing your defense as soon as possible and negotiate with the district attorney to have your charges reduced or dropped if there is not enough evidence. Our attorneys and staff are available throughout the pandemic and can provide sound legal advice to keep you out of jail. To schedule a free consultation, contact our office at (714) 530-9690 or toll-free at (888) 478-8999.