JON'S CELL: If you live in the Milwaukee area, there is a good chance that you are a Green Bay Packers fan. As such, you probably enjoy spending Sunday afternoons watching the Packers defeat the Bears or the Vikings. Sometimes, though, football players teach some valuable off-field lessons to Wisconsin residents.
Recently, the U.S. Department of Justice announced it had filed criminal charges against 10 former National Football League players. The charges stem from a scheme to defraud a health care fund. If you face similar charges, you may want to know how they developed.
The scheme
Before looking at the ins and outs of the health care scheme, you should realize that charges say nothing about the guilt or innocence of anyone involved. On the contrary, in the United States, criminal defendants have the presumption of innocence. It very well may be that the players and others involved in the matter did nothing illegal.
The DOJ alleges, though, that players improperly used a health care fund established in a 2006 collective bargaining agreement. That is, according to information from the DOJ, former players submitted fake claims and asked for reimbursement. The scheme, which ran for approximately 18 months, cost the health care plan nearly $3.5 million.
Criminal activity
Health care fraud is often a federal felony offense. While the NFL case allegedly involved reimbursements for fake medical expenses, the FBI notes that health care fraud sometimes takes different forms. Here are four other common ways to potentially satisfy the elements of the offense:
- Charging insurance companies for equipment a medical professional provided for free
- Billing for unnecessary or unperformed medical tests
- Misappropriating prescription medication
- Submitting forged or fraudulent documents to public or private health care insurers
As the NFL case demonstrates, no one is above the law. Furthermore, the DOJ takes health care fraud seriously. If insurers, investigators, prosecutors or others accuse you of engaging in criminal activity, you must act diligently to assert your legal rights and protect yourself.
