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Understanding health care fraud allegations

When a resident in Minnesota is accused of a serious crime like fraud, it is important to understand what may have led to such an allegation. In many situations, the line between normal business practices and potentially fraudulent activity can be very blurry and very thin. This may make it all too easy for someone to be accused of impropriety because things may look illegal but in reality no wrongdoing occurred. When it comes to health care fraud, there are specific things that are looked for to identify potential illegal actions.

According to the National Health Care Anti-Fraud Association, the manner in which medical services are billed for may contribute to allegations of fraud. Examples include a bill to an insurer for a treatment that some may say is not medically necessary or giving a medical reason to support performing a test or procedure that otherwise would not be covered under the patient's policy. Submitting insurance bills for individual parts of a treatment versus as a whole may end up resulting in more income for the provider and may raise suspicions about fraud.

When an insurance claim bill does not accurately represent the services rendered, that may also be cause for concern, making it important that anyone managing medical billing ensures this is done appropriately.

Health Care Business and Technology explains that allegations of health care fraud may be investigated by the U.S. Federal Bureau of Investigations. Any conviction for these offenses may result in steep fines and even prison time.

 

 

 

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Joseph S. Friedberg Chartered
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