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New Healthcare Fraud Schemes Emerge During COVID-19

Healthcare fraud occurs when a person uses deception to defraud Medicare, Medicaid, or private insurance and obtain some benefit. Various types of actions may be considered offenses, with some typical schemes involving providing unnecessary services or billing for services that were not rendered. In some cases, alleged offenders will unlawfully obtain medical identification information and use it to falsify healthcare claims.

Marketing and Providing Fake COVID-19 Tests

The novel coronavirus disease (COVID-19) has caused widespread fear across the nation, as well as around the globe. The Centers for Disease Control and Prevention (CDC) reported that as of September 1, 2020, the U.S. had over 6 million COVID-19 cases, and 183,050 COVID-related deaths. In Florida, there have been 616,629 cases of COVID-19.

The rapid spread of the novel coronavirus has made people more vigilant about getting tested. They may seek to receive early treatment or to ensure that, if they are infected, they do not come in contact with others and further transmit the virus.

Unfortunately, some people have seen other's fear and the increase in testing as an opportunity to defraud health insurance companies for their own financial gain. The FBI reported that several new types of healthcare fraud schemes have emerged during the COVID-19 pandemic.

One such offense involves people marketing and delivering unapproved tests. The alleged offender may contact an individual in person, by email, by phone, or through social media to tell them that they must take a COVID-19 test. They then ask for the individual's personal and medical information to get the "testing process" started. Often, the test is never given, or a fake test is provided.

The alleged offender might then use the information they obtained to fraudulently bill health insurance programs and keep the money. If the health care program eventually denies the claim for an unapproved COVID-19 test, the beneficiary may end up footing the bill for services that were never rendered.

Investigation of Healthcare Fraud

The FBI is the main agency that investigates healthcare fraud, usually working with other organizations to identify alleged fraudsters. During these lengthy investigations, a government official will interview the alleged offender and attempt to link them to the crime.

People under investigation will often provide statements to officials to try to prove their innocence, and they do so without first consulting with an attorney. Unfortunately, such well-meaning actions can have detrimental effects, as anything the person says can be misconstrued and cause them to unknowingly incriminate themselves. This can strengthen the government's case against them.

If a person is convicted of a healthcare fraud offense, they could be sentenced to prison for years and be ordered to pay thousands of dollars in fines. Also, because COVID-19 healthcare fraud schemes often involve the use of mail or electronic communication, the alleged offender may be charged with mail or wire fraud, which means they might face even more penalties upon conviction.

Hiring a Lawyer to Fight Charges

The rules and regulations concerning healthcare claims are complicated, and an innocent mistake can lead to a criminal investigation. Thus, a person may be accused of wrongdoing when they had no intent to defraud a healthcare program.

In a healthcare fraud matter, it's crucial to retain the services of a lawyer right away, as they can provide skilled legal guidance from the initial investigation to the conclusion of the case.

At the Law Offices of Horwitz & Citro, P.A., we use our experience in complex white-collar cases to protect our clients’ rights. We conduct defense investigations in order to convince the government that our clients should not be charged and to mount a vigorous defense if the government files criminal charges.

Call our Orlando attorneys at (407) 901-5852 or contact us online today.