[{"@context":"https:\/\/schema.org\/","@type":"BlogPosting","@id":"https:\/\/brianzeiger.com\/blog\/constitutes-healthcare-fraud-pennsylvania\/#BlogPosting","mainEntityOfPage":"https:\/\/brianzeiger.com\/blog\/constitutes-healthcare-fraud-pennsylvania\/","headline":"What Constitutes Healthcare Fraud In Pennsylvania?","name":"What Constitutes Healthcare Fraud In Pennsylvania?","description":"With the recent crackdown on healthcare expenditures, the United States has taken a strong stance against healthcare fraud as a means of reducing false claims and, in turn, reducing healthcare costs. The\u00a0Federal Bureau of Investigation\u00a0has units in each of its main offices dedicated to detecting and...","datePublished":"2017-08-01","dateModified":"2023-05-31","author":{"@type":"Person","@id":"https:\/\/brianzeiger.com\/blog\/author\/brianzeiger\/#Person","name":"Brian Zeiger, LLC","url":"https:\/\/brianzeiger.com\/blog\/author\/brianzeiger\/","identifier":12,"image":{"@type":"ImageObject","@id":"https:\/\/secure.gravatar.com\/avatar\/cb403eca94a17a864a2072734e4c5daa47399fd028c5fabaa5499fc0d7c474cf?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/cb403eca94a17a864a2072734e4c5daa47399fd028c5fabaa5499fc0d7c474cf?s=96&d=mm&r=g","height":96,"width":96}},"publisher":{"@type":"Organization","name":"The Zeiger Firm","logo":{"@type":"ImageObject","@id":"https:\/\/brianzeiger.com\/wp-content\/uploads\/2021\/09\/logo.png","url":"https:\/\/brianzeiger.com\/wp-content\/uploads\/2021\/09\/logo.png","width":257,"height":59}},"image":{"@type":"ImageObject","@id":"https:\/\/brianzeiger.com\/wp-content\/uploads\/2021\/09\/What-Constitutes-Healthcare-Fraud-in-Pennsylvania-.jpeg","url":"https:\/\/brianzeiger.com\/wp-content\/uploads\/2021\/09\/What-Constitutes-Healthcare-Fraud-in-Pennsylvania-.jpeg","height":600,"width":900},"url":"https:\/\/brianzeiger.com\/blog\/constitutes-healthcare-fraud-pennsylvania\/","about":["White Collar Crimes"],"wordCount":561,"articleBody":"With the recent crackdown on healthcare expenditures, the United States has taken a strong stance against healthcare fraud as a means of reducing false claims and, in turn, reducing healthcare costs. The\u00a0Federal Bureau of Investigation\u00a0has units in each of its main offices dedicated to detecting and investigating healthcare fraud, but what constitutes such fraud, and can you be convicted of a federal offense even if your intentions were to help a patient in need? The answer is yes, and you should contact a Pennsylvania criminal defense attorney immediately if faced with such charges.Healthcare Fraud DefinedIn a general context, \u201chealthcare fraud\u201d is classified as a\u00a0\u201cwhite collar\u201d crime\u00a0and includes filing false, unlawful, or dishonest claims with a health insurance company, including Medicare and Medicaid, as a means of turning a profit. However, healthcare fraud can also include taking \u201ckickbacks\u201d for patient referrals, waiving patient co-pays, and providing your health insurance company with false information about yourself or your claims. Charges for healthcare fraud are not limited to healthcare providers and can even be brought against patients themselves. Although some of the most common instances of healthcare fraud actually result from identity theft, it is important to recognize that even behaviors one might consider noble, such as waiving co-pays or changing billing codes so that a patient with limited insurance can have a necessary service covered, are considered healthcare fraud and subject the provider to liability.Common Types of Healthcare FraudSome of the most\u00a0common types of healthcare fraud\u00a0include, but are not limited to, the following:Misrepresenting and billing a non-covered treatment as a covered treatment \u2013 for example, billing a nose job as a \u201cdeviated septum;\u201dFalsifying diagnosis codes to justify additional surgeries, medications, and procedures;Waiving deductibles and co-pays and then overbilling the insurer to make-up the difference;Billing for services that were never rendered;Performing medically unnecessary services for the purpose of being able to bill for such, i.e., giving the patient a shot he or she does not need; andBilling for more advanced procedures than what were actually performed, i.e., billing for an expensive 3D ultrasound when the patient really had a traditional 2D ultrasound.Unfortunately, healthcare\u00a0fraud\u00a0in the insurance billing process is common, especially when patients present with insurance plans, such as Medicare and Medicaid, which greatly discount what a physician is permitted to charge for his or her services. This is not an excuse for committing healthcare fraud, but it can become commonplace is an environment where financially troubled patients are in need of medical care they can\u2019t afford and healthcare facilities are trying to make up for the deductions taken by certain insurance companies.Contact Philadelphia Criminal Defense Attorney Brian Zeiger About your Healthcare Fraud Charges TodayIt should come as no surprise that doctors and insurance companies often disagree on the level and necessity of care required by a particular patient, and what a healthcare company might deem \u201cunnecessary billing\u201d a doctor might deem medically necessary for the health and wellbeing of the patient. If you have been caught up in\u00a0healthcare fraud charges, contact\u00a0Pennsylvania white-collar defense attorney\u00a0Brian Zeiger. He can work to review the specific facts of your case and help you defend against those charges.\u00a0Call him today at 215-546-0340 or contact him\u00a0online\u00a0for a confidential, no-risk consultation."},{"@context":"https:\/\/schema.org\/","@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"name":"Blog","item":"https:\/\/brianzeiger.com\/blog\/#breadcrumbitem"},{"@type":"ListItem","position":2,"name":"What Constitutes Healthcare Fraud In Pennsylvania?","item":"https:\/\/brianzeiger.com\/blog\/constitutes-healthcare-fraud-pennsylvania\/#breadcrumbitem"}]}]