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What Is Healthcare Fraud?

When someone makes a misrepresentation or intentionally attempts to deceive an individual or entity about health care while knowing that the deception could result in a benefit to the party that made the misrepresentation, the action constitutes health care fraud. Deliberate omissions, misrepresentations and false statements constitute the most common types of health care fraud in the determination of the health care benefits that are payable. Health care fraud is almost always criminal. There are many different forms of fraudulent billing and reimbursement activities in the health care field, including the following:

  • Billing for procedures or services that were not performed
  • The intentional misrepresentation of the nature of services, the dates of services, the medical records, the diagnoses, the provider’s identity and the charges; or
  • Deliberately performing services that are medically unnecessary in order to secure financial gains

How large is the problem?

Each year, more than $2.27 trillion is spent in the U.S. on health care. Out of that total, billions of dollars are lost to fraud. Losses caused by health care fraud have direct impacts on the government, taxpayers and patients. Patients may also be harmed because of receiving treatments that are unnecessary or from being identity theft victims.

Schedule an appointment today. Call (856) 685-7420 or

Schedule an appointment today.
Call (856) 685-7420 or

Insurance fraud

There are state-specific insurance fraud laws in most states. Some of these laws apply to all types of insurance while others only apply to health care or workers’ compensation. Typically, these laws make it illegal for people to make misleading or false statements in order to support their claims for payments under insurance policies.

Being aware of fraud

You might receive solicitations for free medical procedures that sound legitimate. You should be wary of these types of offers, however. Scam artists sometimes use these types of schemes in order to steal your identifying information so that they can commit health care fraud. Each year, more than $54 billion is stolen in scams through which the thieves make fraudulent claims. This makes all of us pay higher premiums for our health insurance. If someone uses your identifying information, you also may have changes made to your medical history.

Preventing health care fraud

In order to prevent health care fraud, you can do the following:

  • Read your benefits statements and your policy.
  • Read all paperwork that you are sent by your insurance company.
  • Verify that you received the treatments for which your company was billed and question anything that is suspicious.
  • Be wary of free offers.
  • Protect your insurance card in the same way that you protect your credit card.

What to do if you discover fraud

If you learn that you are the victim of fraud, contact your insurance company at once. You should also call the insurance fraud bureau in your state. If your doctor’s office committed the fraud, complain to your state’s medical board.

If you are a senior citizen, do not give out your bank account, Social Security, credit card or Medicare information to people who call you on the telephone. No legitimate Medicare plan can ask for this type of information over the telephone. Drug plans are not allowed to ask you for your information while they are engaged in marketing activities. You are able to sign up for a Medicare plan on the internet, but you must be sent a bill by the plan.

If you are aware of health care fraud that is being committed at your company or learn that you have been the victim of it, it is important for you to talk to an experienced attorney at Swartz Swidler. Fill out our contact form now, and we will get back to you shortly.

Most Frequently Asked Question: Do I Have A Case?

While it is true that every case is different, The law is pretty clear in most cases. The best way to determine if you have a case is to contact one of our attorneys. For more information check out the FAQ below or visit our FAQ Page

Most Frequently Asked Question:
Do I Have A Case?

While it is true that every case is different, The law is pretty clear in most cases. The best way to determine if you have a case is contact one of our attorneys. For more information on a just a few scenarios checkout the flip box FAQ below or visit our FAQ Page.

Our Locations

Cherry Hill Headquarters

1101 Kings Hwy N
Suite 402
Cherry Hill, New Jersey 08034

Phone: (856) 685-7420
Fax: (856) 685-7417

Philadelphia Satellite Office

123 South 22nd Street
Philadelphia, PA 19107

Phone: (215) 995-2733

Our Locations

Cherry Hill Headquarters

1101 Kings Hwy N
Suite 402
Cherry Hill, New Jersey 08034

Phone: (856) 685-7420
Fax: (856) 685-7417

Philadelphia Satellite Office

123 South 22nd Street
Philadelphia, PA 19107

Phone: (215) 995-2733