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Types of Healthcare Fraud

Types of Healthcare FraudThere are many types of healthcare fraud, and the United States government relies heavily on whistleblowers who report fraudulent activity. Anytime a healthcare provider uses misrepresentation on an insurance claim, this is fraud. The False Claims Act makes it possible for healthcare employees to report evidence of fraud in their workplace. Healthcare fraud costs millions of dollars every year.

If you are an employee at a healthcare organization, you can keep an eye out for these most commonly reported health care fraud activities and aid in recovery of government funds:

Health Care Fraud Scheme #1: Billing for Service or Product Never Provided

In some cases, physicians or billing departments will attempt to collect additional money by billing Medicare or Medicaid for services or products they never provided to a patient.

Health Care Fraud Scheme #2: Separate Billing of Services Normally Bundled as One

Many diagnostic tests and procedures are commonly bundled together as one on insurance claims. In some cases, healthcare providers will bill for the bundled procedure and then unbundle the service and bill for each test individually in order to obtain double payment.

Health Care Fraud Scheme #3: Double Billing

In some cases, healthcare professionals may try to bill for a service more than once, as a way to make more money.

Health Care Fraud Scheme #4: Incorrectly Diagnosing a Patient

There are some healthcare services that are only provided by Medicare or Medicaid when the patient has a specific diagnosis. In order to obtain payment for a higher paying procedure, some health care professional may falsely diagnose their patient.

Health Care Fraud Scheme #5: Billing an Uncovered Service as Covered

This type of fraud often happens when a physician is doing a favor for a patient. They want to provide a non-covered service for the patient. Therefore, they bill it as a covered service. Even though motivated by their desire to help out their patients, it is still healthcare fraud.

Health Care Fraud Scheme #6: Accepting Kickbacks from Vendors

The pharmaceutical and medical supply industry is a highly competitive business. Because of this, some vendors may engage in unethical activity to bias physicians to use their product. Anytime a physician accepts a kickback or bribe from a vendor, they commit healthcare fraud.

Health Care Fraud Scheme #7: Use of Unnecessary Services

In some cases, physicians will provide patients with unnecessary services or products normally paid by Medicare or Medicaid. This allows them to receive payment for services they never should have performed.

If you work at a healthcare organization and you suspect your employer may be committing one of the fraudulent activities listed above, you can file a complaint under whistleblower legislation. The laws in place enable to whistleblowers to file a lawsuit on behalf of United States government. Whistleblowers can receive protection from retaliation at the hands of their employer. Also, they may receive a portion of the recovered funds.

Have questions about the different types of healthcare fraud that exist? Click here to get the answers you need from our team at Bothwell Law Group.

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