Health Care Fraud

AHCCCS (Arizona Health Care Cost Containment System) is a Medicaid program that provides healthcare coverage to eligible individuals and families in Arizona. Healthcare fraud involving AHCCCS refers to any fraudulent activity that involves making false statements, providing misleading information, or engaging in deceptive practices to obtain unauthorized benefits or payments from the AHCCCS program.

Healthcare fraud can take various forms within AHCCCS, including:

Provider Fraud: This involves healthcare providers, such as doctors, clinics, or hospitals, submitting false claims for services not rendered, billing for more expensive services than provided, or engaging in other fraudulent practices to receive improper payments from AHCCCS.

Beneficiary Fraud: Beneficiary fraud occurs when individuals knowingly provide false information or misrepresent their eligibility to receive AHCCCS benefits. This can include providing false income information, using another person’s identity, or intentionally misrepresenting their circumstances to qualify for coverage.

Prescription Fraud: Prescription fraud involves obtaining and using prescription medications in an illegal or fraudulent manner, such as forging prescriptions, doctor shopping (obtaining multiple prescriptions for the same medication from different providers), or selling prescription drugs for profit.

Identity Theft: Identity theft can occur when someone steals another person’s personal information, such as their Social Security number or AHCCCS ID, and uses it to fraudulently obtain healthcare services or benefits.

Collusion or Kickbacks: This type of fraud involves illegal agreements or arrangements between healthcare providers, beneficiaries, or other parties to receive kickbacks or financial incentives in exchange for referring patients, prescribing certain medications, or receiving unnecessary services.

AHCCCS takes healthcare fraud very seriously and works diligently to detect, prevent, and investigate instances of fraud within its program. They employ various measures, including data analytics, audits, and collaboration with law enforcement agencies, to identify and address fraudulent activities.

If you suspect or have information about AHCCCS healthcare fraud, it is important to report it. You can contact the AHCCCS Office of Inspector General or the Arizona Health Care Fraud and Abuse Control Program to provide information and assist in the investigation of fraudulent activities. Additionally, you may consider consulting with an attorney who specializes in healthcare fraud or reporting the information to relevant law enforcement agencies.

Phoenix Health Care Fraud Lawyer

Health care fraud is receiving even more attention from the federal government than ever before. This is because there has been a rise in the number of fraud cases that are being prosecuted. For those that are convicted, the penalties are quite severe. They include large fines, lengthy prison sentences, and a criminal record that can hang with a person for the rest of their life. If a professional is responsible for the fraud, then they can lose their ability to practice within the medical community.

If you are being investigated or you have been charged with health care fraud. Myles A. Schneider can provide you with an effective defense. He is a uniquely qualified attorney specializing in many areas of Arizona federal criminal defense.

Health Care Fraud Defined

Health care fraud is considered a white collar crime. This is because it involves defrauding the healthcare system for the purpose of making a profit. When committed, the act entails misrepresenting or deceiving the system by providing false information in a healthcare transaction. The purpose of filing this false information is to make a profit or to receive benefits that are not covered under normal circumstances. Unfortunately, what was considered simple errors in billing in the past is now being prosecuted as fraud. This means that it is possible for a very innocent billing error to cause legal issues and it is a must for a qualified criminal defense attorney to prove that the issue was a simple billing error and nothing more.

Types Of Health Care Fraud

Health care fraud comes with many faces. Providers, the insured, and even employers can commit the crime. Here are some of those acts:

  • A provider billing for services they have not provided
  • Billing for the same service more than once
  • Misrepresenting service description, dates of care, and identities of all involved
  • Non-covered services being billed as covered
  • Medical record modification
  • Intentionally reporting a diagnosis or procedure incorrectly to increase payment
  • Prescribing unnecessary services
  • An insured person providing false information when applying for insurance
  • Using another person’s coverage to receive treatment
  • Forging documents
  • An employer enrolling ineligible employees
  • Establishing fake employee benefit plans

Unfortunately, this is a short list of the acts that can be committed. At the same time, a person can be charged with one of these acts and it be a simple misunderstanding.

Arizona Health Care Fraud Attorney

If you have been charged with health care fraud or you are just being investigated for it at the moment, you need to contact a competent attorney as soon as possible. Federal prosecutors are tough and this is something you do not want to have to face on your own. Instead, you want someone in your corner fighting for you and Myles A. Schneider will do just that. To learn more, call us at 602-926-7373 to schedule a free consultation.