[5] 2 - Fraud

Wrongfully deceives intending to receive financial or personal gain. Fraud is defined as a criminal deception committed by a person who acts in a false and deceitful way. There are a string of offences under a variety of legislation and essentially the suspect will demonstrate some form of dishonesty and/or deception.

Felony Sentence: Up to 20 Month(s) Fine: $5,000

Note:

Fraud can be committed by, and affect, stakeholders across every area of the health care system. Health care fraud is a serious crime that affects everyone's health care and is a costly reality that we cannot afford to overlook.

Examples:

1) Billing for services not provided 2) Billing for more expensive services than were actually preformed, commonly known as up-coding 3) Performing medically unnecessary services solely for the purpose of reimbursement 4) Accepting bribes or kickbacks for patient referrals