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Insurance Fraud: A Quick Way to Jeopardize Your Healthcare Career & Face Jail

Most healthcare providers operate on the up-and-up. They treat patients to the best of their abilities based on the complaints they hear and the symptoms they see. Medications are prescribed accordingly. Medical staff take special care to check patient charts and warn them about possible side effects. They also carry business insurance for medical professionals to protect their practice and staff against general liability and more.

But general liability insurance only covers non-professional negligence of the inadvertent variety. What if a healthcare provider knowingly and intentionally commits a crime for profit? In that case, you're on your own. It's a huge risk, as this type of behavior can jeopardize your healthcare career and possibly result in jail time.

Sometimes, medical practitioners take advantage of other types of insurance payouts after accidents—like auto insurance. For example, a number of South Florida clinic owners and chiropractors are currently facing charges for health care fraud.

Here's how the fraud ring allegedly worked: Clinic owners paid tow truck drivers and others to send automobile accident victims to their clinic for unnecessary treatment. They had their employees exaggerate patient pain levels so they could redeem the maximum PIP insurance payout—$10,000. They also convinced patients to continually visit the clinics, inflating billing. These clinic owners allegedly conspired with attorneys who illegally solicited and referred clients to their chiropractic establishments. The Sun Sentinel reports the fraud ring involves at least $23 million.

Prosecutors say, “The…chiropractic clinics would treat the patients based solely on a profit motive and without regard for patient health.” The clinic owners face up to 80 years in prison and a fine up to either $1,750,000 or double the amount stolen. One of the chiropractors faces up to 70 years and a fine up to $1,250,000 or double the amount stolen. The rest in the case face up to five years and fines up to $250,000. Of course, the outcome depends on convictions.

This is far from the only case of its kind. Recently, authorities uncovered an alleged chiropractic fraud ring in Minnesota to the tune of $20 million.

What can we learn from cases like these? First of all, healthcare providers have a great responsibility to provide honest services to patients. Everything from patient intake to prescriptions and billing needs to be transparent, truthful, and auditable. Phantom billing has long been an issue in the healthcare world, but it's not the only way to commit fraud.

Nowadays, in the era of strict regulation, even a simple oversight can launch a fraud investigation. This is why it's so important for medical practices to develop solid management practices from the get go. Streamlining processes for patient communications, treatment, and billing will make your day-to-day life a lot easier and reduce fraud risk.

According to the Association of Certified Fraud Examiners, various forms of misrepresentation constitute fraud, including:

This just goes to show that organization is key when it comes to keeping your medical practice on track. And, of course, always avoid working with anyone who promises kickbacks or off-the-books profits.

Insurance for medical professionals can protect your healthcare organization against a lot, but not intentional fraud. Wouldn't you rather maintain your professional integrity and practice medicine the honest way?

CoverHound can help you protect your finances against property damage, general liability, and more. Compare policy rates and coverage today!

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Review personalized quotes, select coverages, and buy online - Everything insurance, all-in-one-place.

Insurance shopping simplified

Review personalized quotes, select coverages, and buy online - Everything insurance, all-in-one-place.
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