Health Care Fraud
Health care fraud is serious business with serious consequences. As the most expensive white-collar crime in the country—racking up nearly $100 billion in lost funds involving private insurers and another $100 billion in Medicaid and Medicare–the state of Nevada does not look kindly on this type of fraud. Both state and federal prosecutors are going after individuals and organized groups who engage in this type of fraud with no mercy.
Examples of Fraud
Fraud comes in all shapes and sizes, and might involve individuals who work in hospitals, nursing homes, dentist offices, and more. Staff who try to cheat health insurance companies are a major concern because there are multiple avenues to engage in a swindle, and a successful fraudster can get away with big dollars. Intentionally providing incorrect or false information to an insurance company is the bottom line of every fraud case.
- Insurance companies are double billed for the same procedure;
- Procedures are coded in a way to make billing more expensive;
- Procedures and care that were never delivered are charged;
- The cost of procedures is inflated to make a greater profit;
- Unnecessary medications and/or procedures are prescribed in order to get kickbacks from pharmaceutical companies.
Legal Penalties
In addition to having to pay restitution for money that was essentially stolen from insurance companies, anyone convicted of NRS 686A.2815 could face up to four years in state prison and $5,000 in fines. They will also likely be on the hood for all court costs in the case. Federal penalties are even stiffer, depending on the degree of injury that occurs to the patient. Even with no injuries, perpetrators could wind up serving 10 years behind bars. That doubles in the event of serious injury, and becomes a life sentence in the event of a fatality. All of these sentences are in addition to fines and court costs.
Federal False Claims Act
Anyone—individual or entity—knowingly submitting a fraudulent claim for Medicare, Medicaid, or other federally funded programs, or who intentionally keeps an overpayment for more than 60 days is in violation of the False Claims Act. In addition to having to pay triple the damages suffered by the Government, perpetrators may have to pay nearly $22,000 per falsified claim to the feds. Nevada will take another $11,000, plus three times Government losses.
An Aggressive Defense
If you are facing charges of health care fraud, the experienced Las Vegas criminal defense attorneys at Lobo Law are prepared to put forth a vigorous defense on your behalf. To discuss the particulars of your situation, schedule a confidential consultation in our Las Vegas office today.
Source:
leg.state.nv.us/nrs/NRS-686A.html
