Medical fraud is much more common in the US than most people realize. The decentralized, privatized system creates numerous incentives for fraud. Here are five common examples everyone should know about.
This type of fraud accounts for the majority of Medicare fraud committed in the United States. Phantom billing is when a Healthcare professional or business bills Medicare for treatments that were never rendered. Essentially, Medicare is being asked to pay for a product or service that they didn’t buy.
This type of fraud is often successful because so many requests flow through the system every day that it is impossible to verify all of them.
Falsification of Patient Records
Falsification is another common type of medical fraud. Find patient records is easy for those who are in a position to do so. By claiming that tests or examinations have been carried out, doctors can potentially defraud Medicare of significant sums of money. Falsified patient records might also detail treatments and other procedures that were never actually given to the patient. The impact of falsified patient records can be severe here, potentially impacting the patient’s health and not just defrauding the government.
Unbundling occurs when doctors bill for combined treatments separately. There are numerous treatments and procedures that Medicare treats as bundles for billing purposes. Billing for them separately instead means Medicare pays out more to doctors for the same services.
Double billing is exactly what it sounds like. Double billing occurs when a doctor bills Medicare and or the patient or insurance company for the same services more than once. Of course, this might be an honest mistake. However, proving that it is deliberate is possible in some cases.
Kickback fraud is a particularly insidious type of medical fraud that sees medical practitioners striking private deals with pharmaceutical representatives, clinics, or laboratories. In exchange for money or some other financial reward, these medical professionals agree to shill for a business.
Accepting corrupt kickbacks in this manner is already highly illegal. Medical professionals are banned from accepting money from pharmaceutical businesses and Representatives to push their products. Laboratories are also not allowed to pay healthcare providers a commission for each patient referred to them, as this creates a corrupt incentive.
What To Do If You Are A Victim
Medical fraud can happen to any of us. Many of the examples of medical fraud above can make the patient seem complicit, even when they have no idea that their insurer or health care provider is behaving unscrupulously. Anyone who thinks that they might be a victim of medical fraud or who works in a position to identify and blow the whistle on medical fraud should contact a medical fraud attorney.
Medical fraud attorneys can help you establish whether fraud has been committed and what to do about it. They can also protect whistleblowers’ identities. You should work with an attorney who has experience operating in your state. For example, anyone who suspects medical fraud taking place in Columbus, Ohio should seek out a Medicare Fraud Attorney in Columbus, Oh.
Better awareness about medical fraud makes it much easier to root out and stop. If you suspect medical fraud, you should contact a medical fraud attorney today.