Seven Common Health Care Fraud Schemes

ken-treloar-385255-copy-300x200It is illegal in California to commit health care fraud, yet with the confusing payment bureaucracy for health care in the United States, health care fraud occurs more frequently than most people think. Health care fraud, also known as medical insurance billing fraud, health insurance fraud, Medicare fraud, Medi-Cal fraud, or HMO fraud, takes the form of many different types of improper and illegal actions. By familiarizing yourself with the most common types of health care fraud schemes, you may be able to identify if and when your health care provider is committing health care fraud. If you have information regarding improper billing or other types of health care fraud from your health care provider, call Brod Law Firm at (800) 427-7020 today to speak with an experienced health care fraud attorney and learn more about your rights and remedies today.

Seven Common Health Care Fraud Schemes

  1. Billing for services that were never performed

One of the easiest ways to commit health care fraud, and perhaps the reason why it is one of the most popular, is billing for services that were never performed. It can be tempting for doctors or other hospital staff to throw in a few extra dates and service codes as doing so requires so little work or thought, but billing for services that were never performed is considered health care fraud.

  1. Billing at a higher rate

Doctors may also be tempted to bill at a higher rate than the service they provided warrants. For example, a doctor may bill for an hour long appointment rather than the 30-minute appointment they actually had. Another example is when doctors bill for a more costly procedure than the one administered to the patient.

  1. Billing for a service that was never required

It is unfortunate that this happens since it can result in a lot of pain and anxiety for the patient, but doctors sometimes will misdiagnose patients on purpose in order to convince them to undergo a more costly procedure that they did not actually need.

  1. Double billing

Sometimes doctors will file multiple claims for the same service. Double billing is illegal and considered health care fraud.

  1. Prescribing unnecessary drugs

Similar to misdiagnosing patients in order to prescribe a costly procedure they do not need, doctors sometimes misdiagnose patients in order to prescribe unnecessary and costly drugs to them. This is not only considered health care fraud, but it can also be detrimental to a patient’s health.

  1. Misrepresenting the location of service

While some medical treatments are required by law to be prescribed by a doctor or medical professional in the hospital or clinic, some doctors will provide the patient with the necessary treatment tools and prescribe home treatment instead, yet still bill for on-site treatment. For example, a doctor might prescribe a patient with a needle and syringe filled with a particular drug rather than simply providing the injection for the patient on site. Not only is it a violation of law in certain circumstances to allow patients to administer treatments on their own at home, but it is considered health care fraud to misrepresent the location of service.

  1. Misrepresenting the medical professional who provided treatment

In order to free up time to see more patients, doctors will sometimes pass on their duties to nurses or other medical staff but bill out the service at the doctor’s rate. The law requires all insurance forms to be truthful, and misrepresenting the medical professional who provided treatment is considered health care fraud.

If you have information about a potential health care fraud case, you should understand your rights. You may be entitled to significant compensation as a whistleblower who comes forward on behalf of the United States government to stop abuse and fraud. However you choose to pursue your case, Brod Law Firm will guide you through each step of the legal process

(image courtesy of Ken Treloar)