Common Types of Health Care Fraud

Common Types of Health Care Fraud

Healthcare is a lucrative sector, and people trust the companies and individuals involved. The healthcare sector comprises several related departments – including insurance, hospitals, medical institutions, and several others. However, the presence of fraudsters and scammers is quite apparent in these industries, and thereby, the number of fraud cases is also on the rise. According to the USSC (United States Sentencing Commission) – the number of healthcare fraud offenders in 2022 was 431, which accounted for 8.4% of all property destruction, theft, and fraud offenses.

Often, fraud occurs at the institutional level, which is equipped with crooked lawyers capable of mismanaging evidence and depriving the victim of justice. So, it will be best to call us, the most recommended medical fraud investigation agency, to have enough evidence.

Well-known types of healthcare fraud

Two main types of deceptive practices leading to unmerited profit exist in the healthcare industry: healthcare fraud and healthcare abuse. These patterns cause the loss of billions of dollars at the national level yearly, resulting in higher health insurance premiums and out-of-pocket expenditures for consumers. So, before we proceed any further, let us know their definition:

— A thoughtful misunderstanding or deception of services resulting in an unauthorized reimbursement is called as healthcare fraud.

— Practices that don’t go with the accepted business, medical, and financial practices are called as health care abuse.

These practices can come in many forms, some of which are:

• Health insurance and medical billing

Fraud related to medical insurance and medical billing occurs when a healthcare provider or individual betrays an insurer to obtain more reimbursement. Some of their examples are mentioned below:

1. Presenting a bill for services not performed in real life.

2. Billing each part of a procedure as if it were a different test (also called “unbundling”).

3. Performing a separate procedure and billing a service is more expensive than what actually occurred (also known as “upcoding”).

4. Accepting bribes for referring patients.

5. Creating a false diagnosis of a patient to justify procedures that aren’t medically necessary.

6. Ignoring the co-pays or deductibles of the patient and over-billing the insurance carrier.

• Medicare and Medicaid fraud

Medicare and Medicaid are two benefit programs managed by the government. Dishonest healthcare providers claiming reimbursements from these programs without being entitled and illegally collecting money is usually the common form of Medicare and Medicaid fraud.

• Home healthcare fraud

When home health agencies demand money from insurers, homebound patients, and government benefit programs for unnecessary services or for facilities that they didn’t deliver at all – the company is said to be committing home healthcare fraud. If the homebound patients receive home care as part of Medicaid and Medicare – then it can fall under the government benefit fraud. Incidentally, if the submitted claims are not compliant with federal program conditions, then it is considered a fraud.

General people may not be informed about these in detail and, therefore, must hire the medical fraud investigation agencies like us to get the truth and justified information.

Signing off

People involved in healthcare frauds are smart, and often, the insurance companies are in cohort with these people. However, when you put in a case, you will need to provide proof – which may not be present as the accused are smart enough to hide or destroy it. In that case, we, the most customer-friendly medical fraud investigation agency, can warn the customer before they lodge a case.