A Refresher – The Various Types of Health Care Fraud

We are fortunate to live in a society where advancements in technology make it easier to accomplish otherwise daunting tasks. For example, applying for a credit card used to mean filling out a lengthy application and submitting it through the mail. Finding out whether you have been approved and what your credit limit could take several days. Nowadays, it takes 5 minutes to submit an application online and you find out instantly whether you have been approved. You can choose what you want your new card to look like and expect your new card to arrive in the mail within a few days.

However, as we take advantage of these innovative advancements in technology we also run the risk of being victims of new scams. The FBI warns us of a plethora of scams to watch out for. From advancement fee scams, where someone contacts a victim and requests a payment while promising to pay back the victim an even greater value but never ends up returning the payment, to identity theft where the perpetrator steals a victim’s identity to gain assets or to perform a criminal act, it is important for us to protect ourselves. Although any of these scams may result in substantial financial loss to an unsuspecting victim, health care fraud is a huge epidemic facing our country. According to the FBI, healthcare fraud costs the United States approximately $80 Billion Dollars a year. As the Bay Area’s go to personal injury firm we have represented many victims in health care fraud cases and know how violating it can be.

Examples of Health Care Fraud

Health care fraud can take place in many forms. The National Health Care Anti-Fraud Association claims that organized crime groups are responsible for the majority of heath care fraud. However, dishonest health care providers are also responsible for some of the health care fraud that occurs in our country. Examples of health care fraud committed by health care providers include:

· Falsifying the dates of when the medical service took place or providing a false description of the type of medical service rendered · Changing medical records · Employing unlicensed staff members · Billing the insurance company for medical services that were never rendered · Incorrectly diagnosing a patient to maximize payment · Prescribing treatment that is medically unnecessary
Health care providers are not the only perpetrators of health care fraud. Members of health insurance plans can be held liable for:

· Obtaining prescription pills fully covered by insurance and selling the pills on the black market for a profit · Providing false information to insurance companies when signing up for a health care plan
Another popular type of health care fraud is when manufacturers of medical equipment offer patients free, unnecessary medical equipment and then later bill insurance companies for the equipment. Often times the medical equipment is not even delivered to the patients but insurance companies are billed anyway.

Health care fraud is a serious issue in the United States and violators can be prosecuted through 18 U.S. Code § 1347. If you have any information that may lead to the prosecution of health care fraud contact the California Department of Health Care Services. And if you or a loved one has been a victim of health care fraud please contact one of our experienced health care fraud attorneys today.

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