NRS 686A.2815: Healthcare Fraud Charges In Nevada—Definition, Examples, Penalties

We are now just learning of the extent of healthcare fraud that took place while the entire country was on lockdown for COVID-19. 

Healthcare fraud and insurance fraud are among the hardest hit during the covid lockdown. People made millions while defrauding insurance companies out of payments they were not entitled to. 

This version of healthcare fraud specifically deals with doctors or medical personnel and not the general public. 

As a person seeking medical treatment you may not even be aware that you have become part of a healthcare fraud scheme until it’s too late.

Take, for example, this Nevada doctor who was convicted of defrauding federal medical services of $2 million by referring medically unnecessary prescriptions to a pharmacy and receiving kickbacks.

The crime of healthcare fraud costs the general public billions every year. These fees can come in the form of higher healthcare costs, higher doctor visit fees, and higher medicaid or medicare costs. It seems that health insurance continuously goes up every year even if you don’t ever use it.

Healthcare and insurance fraud are the reasons that our fees continue to go up at an alarming rate. Healthcare fraud is a serious offense that can lead to loss of medical license and prison time. If you have been charged with healthcare fraud it is in your best interest to hire an experienced defense team to help with your case. 

The Defenders represent clients for all types of charges including healthcare fraud, DUI, and robbery. Our team has a reputation for getting clients’ charges dismissed or reduced.

If you or someone you know is facing fraud charges, contact our office today for a free case evaluation.

What is Healthcare Fraud in Nevada?

Under NRS 686A.2815, healthcare insurance fraud is when doctors and their staff deliberately swindle health insurance companies out of money they didn’t earn. 

According to the law, insurance fraud occurs when someone knowingly and willfully submits a claim for payment or benefits under an insurance policy, knowing that the statement includes false or misleading information about a fact material to the claim.

For example, if a doctor treats a patient for one procedure and sends a bill to the insurance company for another more expensive procedure, this is considered healthcare fraud and the doctor or medical staff can be held liable. 

This type of fraud, known as upcoding, occurs when a medical office or its staff intentionally attempt to charge a healthcare provider more than they are entitled to receive.

Even if the health insurance company catches the attempted fraud the doctor or staff could still be held criminally responsible even if the insurance company doesn’t lose any money. 

The attempt of fraud is enough to be convicted.

Types of Healthcare Fraud 

There are several ways that medical staff can commit health insurance fraud. Below are some of the most common ones:

1. Upcoding: The insurance company is charged for a more expensive procedure than the medical office did.
2. Double-Billing: Charging a healthcare company more than once for the same procedure, making duplicate claims 
3. Charging for healthcare procedures that were never given. This includes office visits, surgeries, and tests
4. Inflating the cost of performing medical procedures 
5. Charging for equipment and procedures that were unnecessary or excessive 
6. Falsifying medical records to justify medical procedures that are not necessary
7. Using equipment or medications that are not necessary to get kickbacks from pharmaceutical companies such as trips, cash, and other gifts
8. Unbundling services: Unbundling means submitting all bills for the same procedure separately. This usually increases the cost to both the insurance company and the consumer
9. Using billing codes that are higher than the original codes increasing the costs
10. Conspiring with anyone to do any of the above

Health insurance fraud is also known as HMO fraud, medical billing fraud, and Medicare Fraud.

Federal Healthcare Fraud

Defendants such as doctors, nurses, hospital management staff, and medical administrative staff may be charged with federal healthcare fraud as well as Nevada healthcare fraud. Defendants in these cases will have their cases heard in federal court. 

Federal cases of healthcare fraud often involve federal healthcare insurers such as Medicare.

What Are Best Defenses Against Healthcare Fraud

There are some common defenses that your attorney may use as a strategy against the charges, depending on the circumstances of your case. 

No Intent to Commit Fraud

The crucial component of this crime is intent—specifically, the deliberate act of providing false information to deceive the insurer.

It is not against the law to accidentally give false or misinformation. The health industry is confusing and constantly changing so mistakes are bound to happen.

If your attorney can prove that this information was a mistake and there was no intent to commit fraud, then the charges should be dismissed. This is even true if the mistake causes the health insurer to pay out extra money.

Note, the insurance company may be able to sue the medical staff in civil court to recoup the extra money that was paid out for the mistake.

Police Misconduct

From time to time the police are known to make errors while investigating a case. These include unlawful searches, manipulating evidence, unlawful arrests and coercion.

If law enforcement performs an unlawful search of a medical office looking for documents, the defense team can request that any evidence that was taken as a result of the illegal search to be suppressed and not used in court.

Your lawyer will file a motion to suppress the evidence.

If the evidence is suppressed they may not have a case against you.

What Are the Penalties for Healthcare Fraud in Nevada?

Healthcare fraud is a category D felony in Nevada. Being convicted of healthcare fraud carries a penalty of:

• 1-4 years in Nevada State Prison
• Restitution to the insurance company or companies that have been defrauded
• Court costs
• Reimbursement of the costs to the state to investigate and prosecute the fraud case.

Besides criminal penalties you may face other penalties like suspension or revocation of your medical or professional license. 

You may face additional fines and penalties from the medical board or other licensing agencies. Having this conviction may make it hard to gain employment in the medical field in the future. 

If you have an experienced legal team they may be able to negotiate a charge reduction with the prosecution.

Federal Healthcare Fraud Penalties

Federal law carries much harsher penalties for healthcare insurance fraud. 

The sentence depends on whether the patient sustains serious harm or death.

• If the healthcare fraud resulted in no bodily injury to the patient affected by the fraud, then the penalty is up to 10 years in prison and possible fines.
• If the patient suffered severe bodily injury due to the fraudulent behavior then the penalty could be up to 20 years in prison plus fines.
• If a death results it’s up to life in prison plus fines.

Billing fraud in federal court is presumptive. This means the federal judge presumes that billing fraud charges indicate an intent to defraud. 

The prosecution does not have to prove that the defendant meant to defraud insurers.

Charged with Healthcare Fraud? The Defenders Can Help

If you’re facing healthcare fraud charges, call The Defenders for a case review. Don’t leave these important charges to a public defender. 

These charges could land you in prison for years and you can have your medical license revoked. 

The Defenders have been representing clients throughout Nevada for decades. Our team of experts have the time and resources to dedicate to your case. 

The public defender’s office gives many cases to one lawyer who you may not even meet until right before the first court appearance. 

Don’t make the mistake of leaving your freedom up to just anyone.

Contact The Defenders today for case review.

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