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Fraud, Waste and Abuse: What You Should Know
As a healthcare professional in Texas, you may have undergone training regarding fraud, waste and abuse in the workplace. It is critical that you understand what this entails, as you do not want to be associated with a situation involving fraud.Prescription drug fraud, wage and abuse comes with many harsh penalties, including hefty fines, job loss and potential jail time. Those who are convicted of prescription drug fraud may lose their professional license and have trouble gaining employment in any related health field after completing their penalties.What Is Fraud, Waste And Abuse?
Prescription drug fraud occurs when a person intentionally uses false information, such as a fake name or diagnosis, to get an insurance company to pay for medication, according to the American Pharmacists Association. A pharmacist who uses the wrong insurance or forge prescriptions is an example of fraud. Waste, on the other hand, is involved when a professional or company overutilizes services, resulting in unnecessary costs. For example, a pharmacy sends prescriptions that were never ordered by the doctor or the patient, simply to bill the insurance and obtain payment. Actions that result in extraneous or inflated payments for prescription drugs are known as abuse. This occurs when a pharmacy bills the insurance for a brand name drug and dispenses the generic drug to the patient.
What Penalties Come With Mail Fraud?
In Texas, the law treats mail fraud as a serious crime. If you face related charges, the penalties could have a permanent impact on your life.But just why is mail fraud so heavily punished? And what are the penalties?
How The Law Defines Mail Fraud
The Congressional Research Service examines mail fraud and its related penalties. First, the penalties are high because mail fraud is a felony and federal crime. Why? Because of the use of the United States postal system. Mail fraud involves the use of mail, whether this includes letters, packages, postcards or more. It does not matter if you use a private or public courier, either. All mail travels through the federal post.
Punishment For Mail Fraud Convictions
If convicted, you face imprisonment for up to 20 years along with a fine. For individuals, the fine is up to $250,000. For organizations, it is up to $500,000. If you take advantage of a natural disaster or financial institution, the stakes rise. You could face up to 30 years in prison and a fine of up to $1 million.
How is Fraudulent Intent Proven?
You likely never anticipate that your business dealings could potentially leave you facing charges of fraud or some other federal crime. Yet should your transactions with a particular partner or client not yield the anticipated results (and end up leaving them facing a financial loss or hardship), that could potentially happen?How is it that your actions could come under scrutiny in this manner? The issue may be due to a discrepancy between your client or partner's expectations and the actual circumstances of the situation. Proving this (in defense of accusations of fraud) requires analyzing your intent.
Reviewing The Definition Of "Fraudulent Intent"
According to the U.S. Department of Justice's Criminal Resource Manual, proof of fraudulent may have less to do with the direct evidence related to your case than it does the totality of the circumstances. This can serve to both bolster or weaken your defense of your conduct. For example, the net effect of a business transaction being a significant financial loss for your partner or client (but not necessarily for you) may seemingly imply fraud. Yet you presenting evidence of the ever-present potential for such a loss may counter such an implication (while simultaneously showing you operated in good faith).
What Prosecutors Must Prove in Money Laundering Cases
Before a judge can convict you of a money laundering offense, the prosecutor has certain facts that he or she must establish.According to The U.S. Department of Justice, the evidence of money laundering may be either direct or circumstantial, but it must prove these aspects of illegal activity.
1. Transaction
The prosecutor does not have to prove that you performed a financial transaction, but there must be evidence that you at least participated in the attempt to perform a financial transaction. This could include a sale or purchase, a loan, a gift or a transfer. The transaction must affect commerce between states or internationally and involve wire transfers, money or property, or use a financial institution that affects commerce between states or internationally.
2. Intent
Proving that you intended to participate in a money laundering offense may be more difficult than proving the initiation, conclusion or attempt to carry out a financial transaction. Your intent could be clear if the prosecutor can show that you knew the money, property or other asset came from the committing of a felony at the federal or state level, or from the violation of a foreign law. It does not matter whether you are aware of what the offense or violation is. It only matters that you know that the asset is the proceeds of an illegal action.
White Collar Crime and Your Career
Dealing with the aftermath of your involvement in a white-collar crime will take time and tenacity. One of the biggest challenges you will face is dealing with the damage to your reputation.Working to rebuild others' trust in you and establish professional credibility will require a commitment to change. Your efforts to reestablish your reputation will help you prepare to reenter the workforce with confidence.
Acknowledging Your Wrongdoing
The first step on the road to recovery is to acknowledge your wrongdoing. Be honest with yourself and others. Analyze how your actions resulted in consequences. Identify the root cause that led to your unprofessional conduct. If your actions impacted the lives of others close to you, extend a heartfelt apology and commit to being better.
When you find out the consequences of your behavior, see that you make restitution as soon as possible. Demonstrating your desire to right your wrongs will help people to see your genuine desire to fix what happened.
What to Know About Doctor Shopping
Patients often receive prescriptions from their doctors to deal with health conditions that they suffer from. However, an ethical doctor will not give a patient more medicine than is necessary. Because some people become addicted to prescription medicine, they will try to acquire more medication through methods like doctor shopping.As explained by FindLaw, doctor shopping is a crime under both state and federal law. It is important to know what doctor shopping entails to help avoid any appearance of committing this crime.
Going To Multiple Doctors
A person addicted to prescription drugs will attempt to acquire medication by going to more than one doctor. The addicted individual will visit one doctor, get a prescription, and then go to another doctor to get another prescription for the same drug. This is what it means to "shop" for doctors.
Doctors who obey the law will not write a prescription if a patient already has it. To get around this practice, addicted individuals will keep previous doctor visits a secret from the doctor they meet. By deceiving multiple doctors, the addicted person will acquire prescriptions under false pretenses.
What are the Effects of Healthcare Fraud?
Healthcare fraud occurs in many ways. Sometimes, it is the result of actions from medical professionals, or it may be due to actions by patients.In any case, when it happens, it can create a lot of issues that have a domino effect on the industry. Pacific Prime explains fraud and corruption in healthcare not only costs money but also impacts the quality of healthcare everyone receives.
Strain On Resources
Often, healthcare fraud means patients receive unnecessary tests and take up the time of medical professionals. When this happens, it means you cannot get into the doctor or you have to wait longer for testing. Hospital rooms may go to someone who does not really need it, but then it means there is no room open for you. These things cause a strain on the system and can have a great impact on your overall care.
Insurance Increases
Health insurance goes up because the costs of healthcare go up when there is fraud in a system. Everyone will pay more for services.
Gathering Evidence to Fight False Allegations of Embezzlement
If you are facing embezzlement charges, you likely have high levels of stress and worry about the various ways in which your future is threatened. From financial penalties to a shattered career and the possibility of time in prison, these are serious charges that have the potential to wreak havoc in your life for many years. Unfortunately, some people find themselves in this position over false allegations.According to the Department of Justice, embezzlement involves the misuse of money that was originally obtained in a lawful manner. Although many people facing these charges feel like giving up, it is extremely important to use your time wisely and gather any relevant evidence that will strengthen your defense.
Understanding Why False Embezzlement Allegations Come Up
From confusion to intentionally placing blame on an innocent individual, there are many reasons why false allegations of embezzlement arise. Sometimes, those accused of embezzlement have no idea of how to protect their future and fight the charges. Unfortunately, some people are relatively powerless and unable to prove their innocence and they face harsh penalties for a crime they never committed.
Take Action if You Are Facing an Investigation for Fraud
Auditors employed in a large corporation have more access to financial information than most employees and are perfectly positioned to engage in some form of white-collar crime.If you find that you and other members of the accounting department are under investigation for fraud, what are your next steps?
Understanding White-Collar Crime
White-collar crime is a non-violent crime based on deception, one that often involves abusing a position of trust. In a corporate environment, it might be a crime such as embezzlement, accounting fraud, wire fraud or forgery. The company might not have the internal controls in place to identify issues such as these and the crime could continue undetected for months or even years. Fraud is often the result of pressure, such as personal financial problems, opportunity and rationalization.
Following Up On A Tip
It only takes a tip from a whistleblower for an investigation to begin. However, because white-collar crimes are complex, they are usually of long duration. Some take years to complete. While investigations can begin at the state level, teamwork often develops through the addition of federal resources such as agents from the FBI and IRS.
Understanding Criminal Allegations of Fraud
Financial crimes are considered rather serious, as they can cause significant harm to individuals and companies when committed against them. In many cases, an act of fraud involves intentional acts of deception in order to obtain significant monetary gain. However, a charge of fraud could result even if the amount in question is not large. Thus, considering one's criminal defense options when accused of the criminal act of fraud in Texas and elsewhere is imperative.When a person is facing allegations of fraud, this crime must be proved beyond a reasonable doubt. Thus, the elements of this crime must be proven. Generally, this means that the accused purposefully misrepresented a material fact, they had knowledge that it was false, the victim of the crime justifiably relies on the misrepresentation made by the accused and the victim suffers actual loss as a result.
Fraud is a broad crime and could include criminal acts such as identity theft, insurance fraud, mail fraud, credit card fraud, securities fraud, telemarketing fraud, wire fraud, bankruptcy fraud and tax evasion. No matter the type of fraud one is accused of, it is important to understand not only the elements of the crime but also the evidence used against him or her. This could help with the development of a strong criminal defense.
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