Many people in the greater Philadelphia area rely on federal healthcare programs, like Medicare and Medicaid, to cover all or part of their needs for medical care. Many if not most other Pennsylvanians get their insurance through private companies who also front the money for medical care in exchange for premiums.
What this means is that, in the vast majority of cases, doctors and other medical professionals are billing public or private health plans in order to get their bills paid.
It is of course perfectly fine for a doctor to expect payment for services performed; however, it is against federal law and the laws of Pennsylvania to engage in behavior that is designed to get more money than what is legitimately owed.
Padding bills, billing twice, billing for services not performed, and the like are all forms of conduct that could lead to federal health care fraud charges, as well as other criminal charges.
The penalties for violating the federal laws are strict in that, even for a first offense, a medical professional can face up to a decade in prison and a hefty fine. If there are aggravating circumstances, such as if a patient dies in connection with the fraud, a life sentence is possible.
While there will no doubt be some doctors who get in to tough financial or personal circumstances and make a mistake as a result, the laws are so broad that they can easily net innocent medical professionals who are going to need to protect their licenses, their liberty and their reputations.
In both cases, doctors and other medical professionals facing an allegation that they committed federal crimes should strongly consider speaking with an experienced attorney who frequently represents doctors.
