In Colorado, making false health insurance claims, using another person’s health care information, or submitting fraudulent claims is healthcare fraud. Filing a fraudulent health care insurance claim is a felony offense in Colorado, with penalties including up to 3 years in prison and fines of up to $100,000.
In this article, our Denver Colorado criminal defense lawyers will address:
- 1. What is health care fraud in Colorado?
- 2. What are the penalties for health care fraud in Colorado?
- 3. What are some defenses to health care fraud charges in Colorado?
- 4. Is health care fraud a federal offense?
- 5. Related Offenses
Health care fraud in Colorado generally involves insurance fraud. However, there may be additional penalties and criminal charges if health care fraud involves state or federal healthcare programs, like Medicare or Health First Colorado.
Under Colorado law, a person commits health insurance fraud when he or she, with the intent to defraud:
- Presents an application for a health insurance policy that contains false information or withholds material information resulting in insurance coverage;
- Makes a claim for an injury that contains false material information or withholds material information;
- Participates in a staged car accident claiming injuries; or
- Makes an oral or written statement in support of a medical insurance claim for payment, knowing the statement contains false information or withholds material information.
There are many ways individuals, agents, or health care providers can commit health care fraud. Individuals may seek treatment under another person’s health insurance. However, health care fraud often involves medical providers fraudulently billing insurance companies or government medical services. This includes:
- Submitting duplicate claims for a single procedure
- Billing for medical care or services that were never provided
- Billing for patients who were never treated
- Billing for more expensive services than were provided, or “upcoding”
- Performing unnecessary surgeries or procedures
Submitting a health insurance application with false information or failing to provide material information is a class 2 misdemeanor.1 Penalties include up to 120 days in jail and/or up to $750 in fines.
Other health care fraud, including filing a false claim or submitting a claim for fraudulent services, may result in felony criminal charges. Health insurance fraud is a class 5 felony. The penalties for health care fraud include 1 to 3 years in prison and a fine of up to $100,000. There is also mandatory parole for 2 years for a health care fraud conviction.
In order for the prosecutor to prove you are guilty of health care fraud, they have to prove beyond a reasonable doubt that you intended to commit fraud. This requires establishing the plaintiff’s culpable state of mind. Possible defenses to health care fraud charges include showing that:
- The plaintiff did not knowingly enter false information in your health insurance application;
- The plaintiff did not intend to commit fraud when entering a false statement;
- Any duplicate or incorrect claims were submitted by mistake; or
- Another person was responsible for submitting false information.
Health care fraud may result in federal criminal charges. Health care fraud is a federal crime under 18 U.S.C. 1347. Federal health care fraud includes defrauding any health care benefit program, or obtaining any money or property by means of false representations.
The penalties for federal health care fraud include fines and imprisonment for up to 10 years. If health care fraud resulted in serious bodily injury, a conviction may result in up to 20 years in prison.2
Health care fraud may involve other related offenses. Making false health care insurance claims may constitute insurance fraud. Using another person’s personal information may be identity theft. Using fake or altered insurance or medical documents may also result in forgery charges.
In Colorado, it is a criminal offense to use another person’s personal or financial identifying information to obtain anything of value. This includes using another person’s identity in a health care transaction to commit health care fraud. Identity theft can be a felony or a misdemeanor.
Making misrepresentations in an insurance application or filing a fraudulent insurance claim is a criminal offense. Under C.R.S. 18-5-211, the penalties for felony insurance fraud include up to 3 years in prison and fines of up to $100,000.
In Colorado, altering a document with the intent to defraud is felony forgery. This includes altering or making a fake health care document or insurance card. Under Colorado law, the crime of forgery in the first degree is a felony. Penalties for forgery include up to 3 years in prison and a fine of up to $100,000.
Call us for help…
If you have been accused of health care fraud, please contact us at Colorado Legal Defense Group. Our caring Colorado defense attorneys have many years of experience representing clients who have been charged with criminal fraud offenses. We are among the best Colorado criminal defense attorneys to call. Contact us today by phone or in-person or in our Denver law office.
In California? See our article on health care fraud (Penal Code 550 PC).
In Nevada? See our article on health care fraud.