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Can a doctor lose their license over suspected insurance fraud?

On Behalf of | Sep 29, 2023 | Medical Licensing

When allegations of insurance fraud arise against a doctor, the consequences can be severe, potentially extending beyond legal repercussions.

These types of fraudulent charges may include billing for services not rendered, misrepresenting diagnoses or treatments or even colluding with patients to file false claims. Regardless of the charge, it may mean a potential loss of a medical license.

Legal repercussions

If charged and subsequently convicted of insurance fraud, a doctor may face hefty fines, restitution orders and even imprisonment. The severity of these penalties often depends on the extent of the fraudulent activities and the laws of the specific jurisdiction. Insurance fraud is a serious crime, and legal authorities are diligent in prosecuting those suspected of such actions. In fiscal year 2022, False Claims Act settlements and judgments exceeded $2.2 billion.

Professional consequences

The professional fallout of an insurance fraud charge can be just as devastating as the legal ramifications. The medical field operates under a strict code of ethics and professional standards. Doctors must adhere to these principles, or they risk facing disciplinary action and losing the respect of their peers.

License revocation

One repercussion a doctor may face following insurance fraud charges is the potential loss of their medical license. Licensing boards may start their own investigation, separate from any legal proceedings. If the board determines that the doctor’s actions constitute a breach of professional ethics, they can impose sanctions ranging from temporary suspension to permanent revocation of the medical license.

Recovering from insurance fraud charges and the resulting loss of a medical license can be an arduous process. Even if a doctor is eventually reinstated, they may face a long road to rebuilding their professional reputation and the trust of their patients.