Health care fraud is defined in Title 18 U.S. Code § 1347 as knowingly and willfully executing, or attempting to execute, a scheme to defraud any health care benefit program in connection with the delivery of or payment for health care benefits, items, or services. Additionally, anyone involved in a conspiracy to commit fraud can be charged under the same offense. It is in this way that everyone within an entire company can be implicated by health care fraud charges, catching many law-abiding people completely off-guard.
Examples of Medicare and Medicaid fraud include:
- Obtaining prescription drugs through a welfare program that is later sold for profit
- Billing for services that have a higher repayment than the actual service performed
- Billing for services that were never performed
- Billing for an un-covered service when a covered service was provided
- Filing duplicate claims for the same service
- Misreporting income in order to collect benefits
- Loaning another person your insurance card