In recent years, much has been written about the need for reform of the American health care system. High costs are often driven by health insurance companies that often dictate what health care providers and types of procedures are covered. In many cases, billing to private health insurance and Medicare is a complex and often misguided process carried out by business administrators, secretaries or even doctors themselves in the case of sole practitioners.

One dermatologist was recently sentenced to more than a year in prison on charges related to health care fraud. The criminal charges stemmed from allegations related to the doctor’s insurance billing procedures. According to legal documents, the doctor in question was accused of engaging in false and fraudulent billing practices from 2007 through 2011.

During these years, the prosecution in the case asserted that the doctor routinely billed both private insurance companies and Medicare for procedures which were cosmetic in nature and therefore not covered under insurance. Procedures for which reimbursement was submitted included laser skin treatments as well as chemical peels to aid in the removal of sun spots and wrinkles.

In response to the criminal charges and allegations purported against the doctor, her defense attorney insisted the billing errors were honest mistakes. The doctor named as the defendant in this case was ultimately responsible for the billing process and failed to take quick corrective action once the mistakes were discovered. As a result, the doctor was indicted on 96 counts of health care and wire fraud.

Criminal charges related to health care fraud are serious in nature and can result in those individuals convicted paying hefty fines and serving time in prison. Individuals accused of such crimes would be wise to seek the advice of a criminal defense attorney who has experience in handling such matters.

Source: Decatur Daily, “Lauderdale doctor gets prison in fraud case,” Mike Goens, April, 25, 2013