Health Care and Insurance Fraud

Health Care and Insurance Fraud

Seven individuals from Penn Choice Ambulance, Inc., a Philadelphia company, were charged on April 10 with health care insurance fraud as a result of an FBI and Office of Health and Human Services fraud investigation. Those arrested allegedly billed Medicare for $3.6 million in unnecessary ambulance rides.

The suspects were also charged with related crimes involving making fraudulent Medicare claims, making false statements regarding health care issues, aggravated identify theft, paying kickbacks to patients, and money laundering. The bank accounts and other assets were seized and could be subject to criminal forfeiture.

Insurance Fraud Among Most Costly White Collar Crimes

Insurance fraud is among the most costly of the white-collar crimes in Pennsylvania and the nation. Estimated losses passed onto consumers are in the billions annually.

In Pennsylvania, the largest law enforcement arm is the Office of the Attorney General’s Insurance Fraud Section. It has the authority to investigate and prosecute those suspected or involved in fraud, including insurance and health care insurance fraud.

Insurance fraud investigators are generally not out in the field. Rather, they are investigating behind the scenes. They are looking for unusual billing patterns or payment patterns, and are investigating whistleblowers’ information. They are also seeking to determine whether the overpricing was just a mistake, or whether there was a consistent effort on the part of a medical provider to defraud the insurance company.

Health Care Insurance, Car Insurance, Workers’ Comp Fraud

Health care insurance fraud happens when a false claim or a misstatement of the facts results in unwarranted profit from a patient’s medical coverage.

Insurance fraud can involve:

  • Insurance fraud involving a car crash or workers’ compensation, in which individuals lie to achieve financial gain
  • Medical provider insurance fraud involving up-coding to obtain higher insurance payments, overpricing of the cost of medical services, prescription drugs, and durable medical equipment
  • Forging someone else’s name to provide coverage to someone not under the police
  • Inflating prices unlawfully
  • Charging for branded products but selling off-label generic drugs and durable medical equipment
  • Sending a patient to a medical facility in which the medical professional has an interest without full disclosure of the relationship

Questions About Health Care and Insurance Fraud? Knowledgeable PA Criminal and Administrative Defense Attorney: 610-565-0240

If you know you are under investigation for fraud, it is critical that you obtain the guidance of an experienced criminal and administrative law defense attorney. At the Law Offices of John E. Kusturiss, Jr., in Media, Pennsylvania, you will find attorneys who can help. To discuss your concerns in a free initial consultation that is confidential with an experienced defense attorney, please contact the 610-565-0240 or email us.

We are based in Media, Pennsylvania, and represent clients who are being investigated for or who have been arrested for suspicion of health care insurance fraud, car insurance fraud, workers’ compensation fraud, or other white collar crimes, as well as DUI, theft, and other misdemeanors and felonies.

We also handle cases involving divorce and family law, and personal injury law throughout Springfield, Chester, Upper Darby, Ridley Park, Newtown Square, and Havertown, PA.

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