Understanding Healthcare Fraud and Health Insurance Scams

Common Acts of Healthcare Fraud and Other Health Insurance Scams

The Centers for Medicare & Medicaid Services reports that the national health expenditures in the United States were at $2.6 trillion in 2010. This amount grew to $3.5 trillion by 2017. While many of these services are properly provided, there are also numerous health care fraud schemes that are known to occur. The following takes a brief look at a few of the most common health insurance scams.

Billing for Services Not Provided

One of the most common types of healthcare fraud is submitting claim forms for reimbursement for services that were never provided. These claims often merely require listing extra dates and medical procedures on a claim form, which means that this type of fraud is often an attractive option. Fraud examiners, however, are trained to look for periods of billing and care that lack documentation.

Billing for Non-Covered Service as Covered Service

Some types of health care providers attempt to disguise medical procedures that are not approved by the government or insurance company as approved treatment. Medical professionals sometimes do not even see anything wrong with this behavior and argue that it is helping patients who require procedures that have not yet been approved by the government or insurance companies.

Misrepresenting When Service was Provided

Medical professionals sometimes stand to make money if they report patient visits on two separate days rather than one. This is because many medical professionals bill a fee for each “office visit.” Often, the services reported were actually provided, but the dates are not correct.  

Misrepresenting Location of Service

Some healthcare providers are known to bill for services that they provided while patients were at home as services that were provided at clinics. One of the most common ways in which red flags are raised in these situations is when services are billed for Sundays.

Misrepresenting Who Provided Services

Some individuals impersonate medical providers and bill for treatment. Sometimes these people do not have the licenses necessary to provide the care in question. Some medical providers have never been trained to provide any type of service.

Waiving Copayments and Deductibles

Many government health care plans and insurance companies do not permit medical providers to waive patient co-payments or deductibles. Some people have argued that patients who are required to pay even a small amount for medical services are only like to seek care if it is absolutely necessary.

Speak with an Experienced Federal Criminal Defense Lawyer

While this article has reviewed some of the most common types of healthcare fraud, there are many more. Being charged with health insurance fraud can result in serious penalties. If you have been charged with health care fraud, obtain the assistance of an experienced criminal defense attorney who can make sure that your case resolves in the best possible manner. Contact the Federal Criminal Law Center today for assistance.