Insurance Fraud within the medical field has become a prevalent and lucrative enterprise not only for practitioners and patients but for sophisticated organized crime rings as well. Schemes ranging from fraudulent billing and kickbacks to prescription compounding drug conspiracies are driving up the cost of healthcare nationwide.
The National Health Care Anti-Fraud Association conservatively estimates healthcare insurance fraud costs the nation 68 billion dollars annually. This results in higher premiums and higher costs for those of us who follow the rules. Unfortunately Kern County is not immune from this type of criminal behavior. Even more disheartening is the reality that oftentimes the perpetrators are the people we trust the most.
Health Insurance Fraud occurs when a provider of health services or even a private person offers false or misleading information to a health insurance company in an attempt to obtain payment for service or unauthorized benefits. Many people feel this is a victimless crime because typically impacted are the insurance companies which are perceived as large corporations that can afford the cost of fraud; but in reality those costs are passed on to the consumer. Not as often considered are the individual victims of this type of fraud; patients who are subjected to unnecessary procedures or victims of medical identity theft.
Fortunately this type of crime is a felony, and is punishable in California by up to five years in prison and/or significant fines. Healthcare fraud can also be prosecuted on a federal level and can carry a sentence up to ten years; twenty years if the fraud results in serious bodily injury, and a potential life sentence when the fraud results in someone’s death.
The Kern County District Attorney’s Office takes this type of crime seriously and has a Disability and Health Care Insurance Fraud Unit dedicated to thoroughly investigating and prosecuting those who commit fraud. This unit works closely with law enforcement agencies across the State of California in an effort to combat and prosecute fraud which often extends into other cities and counties, states and sometimes internationally.
If you suspect or have reason to believe Disability and/or Healthcare Insurance Fraud is occurring in Kern County, please call the District Attorney’s Office Fraud Hotline at 1-800-619-3039 or or use our contact form to email us.
If you’re interested in reading more about Health Care fraud here is a link to an excellent article by By Charles Piper, CFE, CRT.