How is health care fraud committed?

Health care fraud is a type of white collar crime committed when someone knowingly misrepresents facts and/or conceals information for financial gain within the health care system in California. Health care fraud typically involves either submitting a claim for services or goods not received, submitting a claim for procedures and services that are not medically necessary, or billing multiple times for the same service or goods. One of the most common forms of health care fraud committed in California is when a health care provider bills insurers or government health programs like Medicare or Medicaid for services or equipment that weren’t actually provided or were unnecessary. This is sometimes referred to as “upcoding” or “unbundling”. In California, health care providers who engage in fraud can also be found guilty of providing kickbacks or bribes to patients or other health care providers in exchange for referrals. This can be especially dangerous, as it can influence the type of treatment a patient receives, potentially leading to further health issues if the patient receives care from an untrained or unlicensed provider. Additionally, false marketing of prescription drugs, billing for ghost patients, and failing to disclose a financial interest in a company that is being billed for services are all examples of health care fraud that can be committed in California. Individuals and companies who commit these types of crimes can be subject to significant financial penalties and even prison time.

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