18 former NBA players who set out to defraud insurers for claims worth millions of dollars are facing charges of insurance fraud and identity theft. The defendants, including one of the players’ spouse, were each charged with one count of conspiracy to commit health care fraud and wire fraud and one of the defendants was charged with aggravated identity theft.
What Is Health Care Fraud?
Health care fraud is a federal crime. It is a type of insurance fraud that is taken particularly seriously. Health care fraud affects health care premiums and taxpayers wallets and can sometimes result in injury and death — thus the penalties associated with it are severe. A conviction can result in a maximum 20 year prison sentence and/or fine. Insurance fraud is a crime in 50 states, but health care fraud is also a federal crime.
The acts that can be considered healthcare fraud include:
- Billing for services not rendered. The alleged Ex NBA player scheme involves billing for services not rendered. The road to committing this crime can include other crimes such as forgery, identity theft and bribes or kickbacks to medical professionals or others involved in the scheme.
- Excess services: billing for services that exceed the level of care required
- Unnecessary services: billing for services that weren’t required. The alleged Ex NBA player scheme involved claims for multiple root canals (in one case 17 root canals in one year).
- Upcoding of procedures or items: billing for procedures or items, (such as medical equipment), that are more costly than the item or procedure that was actually received.
- Duplicate Claims: charging an insurer twice for a procedure
- Bribery and kickbacks: using gifts, cash, professional honors and other incentives to get medical professionals to participate in schemes or prescribe certain drugs.
Healthcare fraud may be committed by a patient (or someone who tries to claim on behalf of a patient), or by a medical professional or someone adjacent to the medical profession such as someone working in a pharmaceutical company or insurance company.
What Is Insurance Fraud?
Insurance fraud is a type of fraud in which the insurance process is manipulated by someone who attempts fraud for their own benefit.
Healthcare fraud is a serious type of insurance fraud. It’s important to remember that in the case of a criminal healthcare fraud accusation, it has to be proved beyond all doubt that a person knowingly made false statements and these were connected to the healthcare claim and impacted on the healthcare claim. Healthcare fraud and insurance fraud accusations vary wildly in their seriousness and the consequences associated with them. If you are accused of healthcare fraud, you need a strong defense and an experienced criminal defense attorney who will not allow prosecutors to push for a harsh and undeserved conviction.
Insurance fraud is considered more or less serious depending on whether it is “hard fraud” or
“soft fraud.” Hard fraud typically involves someone deliberately fabricating a claim or loss, or in some way deliberately manipulating the process. The alleged NBA player scheme earned the players $2.5 million. The defendant who is alleged to have orchestrated the scheme, Terrence Williams, allegedly received kickbacks of at least $230,000 from players participating in the scheme.
Deliberate schemes to defraud health insurance companies are not as common as so-called “soft fraud,” or opportunistic fraud, where a defendant may exaggerate the seriousness of a claim or misrepresent a preexisting condition.
The ex NBA players are alleged to have participated in a scheme in which they knowingly defrauded a health-care program that was meant for current and former NBA players. Prosecutors cited the victims of such a crime as other people participating in the scheme. Health-care fraud is one of the most serious types of fraud due to its potential for bodily harm and impact on taxpayers and other policyholders. Even if you believe you have not done something that deserves serious punishment, it’s important to retain a skilled criminal defense attorney immediately if you have been accused of healthcare fraud. If you are concerned about an accusation of healthcare fraud that may result in serious consequences, please don’t hesitate to contact the experienced healthcare fraud attorneys at Dhar Law, LLP.