Nevada Healthcare Fraud Attorneys Explain Criminal Charges for Fraudulent Medical Billing

Defrauding a health insurance carrier in Nevada is a crime under state and federal law.

Health care fraud in Las Vegas shares many of the same elements as other types of fraud, such as bank fraud or wire and mail fraud, but it is different because a person with a professional license- like a doctor- may lose his or her right to practice in the medical field.

Fraud is always a serious crime in Las Vegas. Healthcare fraud is especially serious because even charges, without a conviction, can have a negative impact on your professional reputation and career.

If you are suspected of Medicare or Medicaid fraud, or have been arrested for healthcare fraud in Nevada, contact us today to begin defending your case.

Legal Definition of Nevada Medicare Fraud

The legal definition of healthcare fraud is very technical because it covers many types of behavior. NRS 686A defines insurance fraud as knowingly and willfully:

  • Presenting any statement to an insurer that conceals or omits facts or contains false or misleading information which is important to the insurance carrier in making a decision to issue an insurance policy;
  • Presenting a claim for payment or benefits under a healthcare insurance policy even though the claim conceals or omits facts or contains false or misleading information concerning any material fact about the claim;
  • Assisting or conspiring with another person to present any statement to an insurer that conceals or omits facts or contains false or misleading information for the purposes of issuing an insurance policy;
  • Acting or failing to act with the intent of defrauding a health insurance company to obtain an insurance policy or benefits;
  • A medical practitioner encouraging another person to commit a fraudulent act to deceive an insurance company;
  • Accepting money or benefits from a health insurance policy that results from a fraudulent act or omission described above;
  • Employing a person to find patients who obtain benefits from health insurance policies for the purpose of engaging in any of the acts listed above; or
  • Participating in, aiding or abetting, conspiring, or permitting an employee to commit any act or omission listed above to gain unjustified benefits from a healthcare insurance policy.

Sentencing for medical billing fraud in Nevada

If a person is convicted of Medicare fraud because they did any of the activities listed above, he or she can be punished by a Category D felony in Nevada. Category D felonies carry 1 to 4 years in a Nevada prison and fines up o $5,000.

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Nick Wooldridge has a long track record of representing clients accused of serious federal and state crimes in Nevada.


Health Care Fraud under Federal Law

Health care fraud is also a federal crime. The federal crime has much harsher penalties than Nevada law, including prison time of up to 20 years.

Another difference between federal health care fraud and the Nevada crime of healthcare fraud is the intent requirement. Almost all fraud crimes require the prosecution to prove that the defendant acted knowingly and willfully for the purpose of defrauding a person or company, or in this crime, a health insurance carrier. The federal crime of health care fraud, on the other hand, does not require a person to know that he or she is defrauding an insurance company by doing any of the acts listed above.

This makes the federal crime slightly easier to prosecute, and is another good reason to hire experienced Las Vegas federal criminal lawyer as soon as possible.

Medical Billing Fraud Resources in Nevada

NV Attorney General – Medicaid Fraud Control Unit (MFCU)
702-486-3420 – Reporting Medicare Fraud
Nevada Division of Insurance
2501 East Sahara Ave., Suite 302
Las Vegas, NV 89104
(702) 486-4009

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More Information

Health care fraud cases often make local and national news, which can ensure that a medical professional’s reputation in the community is destroyed.

If you have been arrested for health care fraud, contact Nick Wooldridgea Nevada criminal defense lawyer as soon as possible. He can work diligently to reduce the charges against you, restore your reputation, and possibly get the charges dismissed.