California’s complex regulations for health care can make it challenging for providers to stay in compliance. A provider might not even be aware of unintentionally breaking certain laws.
Since the justice system vigilantly reviews health care fraud and malpractice allegations, medical professionals should stay alert to mistakes that can lead to prosecution and compromise their licenses.
Types of health care fraud
Fraud in health care can fall under many categories. The practice typically involves receiving illegal compensation through filing fraudulent claims. For example, a doctor might practice medicine under pretenses because of lacking the appropriate license. A physician could fall into this situation because of failing to renew a license or missing continuing education credits.
Another challenge is billing and coding. These processes are complex and involve a lot of numbers, which can lead to mistakes. Doctors need to watch out for the following errors:
- Receiving kickbacks
- Performing unnecessary services
Health care fraud often involves Medicare or Medicaid, so physicians need to pay attention to paperwork for services involving these programs.
How the system treats accusations of health care fraud
A conviction for fraud as a medical professional could lead to fines, incarceration and loss of a license. The Federal Bureau of Investigation handles the case and has a reputation for aggressive prosecution. A defendant usually needs substantial evidence to overcome the charges.
Health care fraud accusations are unsettling for a physician or medical team. Understanding the types of charges can help a doctor avoid them or defend against them.