Insurers are constantly on the lookout for people trying to defraud them. They know that some people will try to claim for injuries or illnesses they don’t really have. Or they will try to get more money by claiming they are worse than they actually are.
In some cases, they will convince the medical professional they really have that condition. In others, they might be in league with a medical professional willing to write them the paperwork to support their exaggerated or false claims.
Medical facilities can also commit fraud on their own by exaggerating the costs of the treatment they provided, billing for actions they did not perform, or drugs they did not hand out.
There is a common factor in all three scenarios
Someone has to write the receipts that get sent to the insurer. Typically this is an employee hired to take charge of billing and other administrative tasks.
They may have no idea of the deceit going on behind them. All they do is carry out their job, writing the things they are told to write and sending them to the insurance company. Yet, if the place they work is involved in a suspected case of fraud, the investigating authorities may assume that the person doing the billing knew the details were incorrect. Thus they may bring charges against them as part of the investigation.
Just because you are innocent and just because you were only doing what you were told does not guarantee you will escape conviction. Getting legal help will increase the chance you do.
