What Fraud in Healthcare Means
Fraud cases in the healthcare sphere are prosecuted under Article 180 of the Criminal Code of Georgia. Fraud is defined by law as taking possession of another person’s item, or acquiring a property right, by deceit with the aim of unlawful appropriation. In medical practice this usually describes a situation where a patient, an insurance company or a state program pays for services, supplies or procedures that were not actually performed, are presented differently, or are recorded in inflated amounts. Such cases often begin with an audit and quickly pull in several people at once — physicians, clinic administrators, accountants.
It is important to understand that the law does not set a separate penalty for this sphere — the general norm on fraud applies — yet the specifics of healthcare make these cases particularly complex: medical documentation, diagnostic records and financial reporting are intertwined, and the prosecution often relies on expert conclusions that require independent verification.