Health Care Fraud Is a Thesis

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In the case of pill mills, participating physicians and pharmacists bill insurance companies or Medicare for prescription drugs, allowing participating beneficiaries to resell those drugs to criminal middlemen. The pharmacy then repurchases the drugs at a lower cost. According to the USGAO, any misuse of beneficiary identification information is a felony.

Criminals may also steal beneficiary information by creating drop boxes. The drop box scheme involves establishing a phony health care company in order to obtain insurance or Medicare payments. Like the drop box scheme, the pill mill scheme, and the rent-a-patient scheme, third-party billing also involves felony acts. Illegally obtaining beneficiary identification numbers, a criminal can use third-party billing agents to receive insurance payouts. The third-party billing company may not even be aware of the scheme.

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In other cases, the third-party billing company is a part of the scheme, defrauding by tacking on fraudulent claims to legitimate ones and then receiving insurance payments.

Other types of health care fraud include simple one-time billing for services that were never rendered. For example, a hospital might claim an ambulance was used when it was not or a doctor's office might overstate how many X-ray examinations a patient received. Any attempt to defraud an insurance provider is a potential felony, but the severity of the charges will vary depending on the extent of the crime. One instance of fraud might warrant a fine, whereas more extensive and deliberate schemes could lead to a prison sentence......

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