Common Types of Healthcare Fraud

Common Types of Healthcare Fraud

Without a doubt, the majority of health care providers are honest and hard-working people. These professionals are dedicated to helping patients improve their health.

Unfortunately, there are numerous medical professionals who take advantage of the health care system in order to line their pockets. These providers will engage in schemes that not only have a devastating impact on patients but often result in billions of dollars in losses to the healthcare industry. Unfortunately, there are several practices that healthcare engage in that have a devastating impact on the quality of care patients receive.

Billing for Services not Rendered to Patients

This form of fraud is relatively common. There are numerous instances where health care providers bill insurance companies for services that are not actually rendered to patients. In some cases, medical providers will bill for inaccurate services or attempt to bill for services that were not provided to patients at all. In some cases, medical providers will try to bill for services that are not even medically necessary.

Billing for Non-Covered Services

Medicare laws provide various exemptions for services. These services are generally never considered for payment. For example, a care provider may attempt to bill an insurance provider for a toe surgery, which is covered, after performing a routine nail clipping for a patient.

Misrepresenting Dates of Services

This type of false claim violation occurs when medical offices submit claims for payment to cover services on multiple days when they did not actually see patients on the times listed. Given the fact that each office visit is treated as a separate billable event, they are able to generate more money when they break down multiple services provided in one visit and bill them as an array of services rendered over several days.

Misrepresenting the Location Services Were Provided

There are numerous cases where patients receive in-home care. Rather than billing these services as such, some healthcare providers will bill the insurance as an in-office visit. Visits in-office generally cost more, which results in an overpayment to the provider for services provided to the patient.

Misrepresenting Provider of Services

These fraudulent actions occur when care providers charge for services and list a different person as the provider. For example, a patient may have visited the office and received minimal treatment or services from a nurse in the office. Rather than billing the insurance for a routine nurse check-up, providers bill the insurance company for a visit with a surgeon, specialist, or another practitioner to generate a larger bill.

What to Do if You are Accused

Unfortunately, the increased number of care providers engaging in fraudulent actions places innocent and moral care providers at risk of being falsely accused. Being charged with healthcare fraud can have a detrimental impact on a professional’s career. If you were accused of these fraudulent actions or other actions that constitute healthcare fraud, it is crucial that you reach out to an aggressive healthcare fraud attorney as soon as possible to protect your legal rights.

Our team at Healthcare Fraud Group is dedicated to helping those accused of these crimes have charges thrown out or reduced. Contact our law firm today at 888-402-4054 to schedule a free case evaluation to explore legal options available for you.

Schedule a Confidential Initial Compliance Assessment with Our Federal Health Care Group