What is Healthcare Fraud?

Health care Fraud

Although most people have heard of healthcare fraud, few really understand exactly what it is. Most people assume that healthcare fraud occurs when people intentionally set out to steal millions from insurance companies, Medicare and Medicaid programs. However, most cases of healthcare fraud are far more innocuous. In fact, you’d be surprised how easy it is to commit healthcare fraud without even intending to!

Healthcare fraud can be committed by healthcare professionals, patients, insurance companies and even official programs. As there are so many different types of healthcare fraud, it’s important to understand the various ways in which fraud can occur:

1. Intentional Dishonesty

If someone sets out to commit fraud, they will dishonestly appropriate funds from an individual or an organization. A physician might intentionally bill for treatments they have never provided in order to obtain funds from an insurance company, for example. 

2. Accidental Errors

In some cases, allegations of healthcare fraud can arise because of an accidental error. Double billing is a common type of healthcare fraud and occurs when physicians submit two bills to an insurance company or assistance program, rather than one. Alternatively, Medicare, Medicaid or an insurance company may send two bills to a patient. However, this can easily be caused by administrative error, rather than intentional dishonesty. 

3. Kickbacks

Another type of healthcare fraud occurs when practitioners accept kickbacks, commissions or financial incentives. A laboratory may offer a physician a commission for every sample they submit to them for processing, for example. There are strict laws prohibiting this conduct, which means that receiving a kickback or commission is considered to be healthcare fraud. 

4. Waiving Deductibles 

Even when patients have insurance or are covered by the Medicare program, they often have to pay a deductible or make a co-payment when they obtain medical services. However, some physicians have committed healthcare fraud by waiving these fees. In some cases, physicians may seek to reimburse themselves by billing for additional services, whereas other healthcare professions may simply accept the financial loss. Even if a practitioner does this in order to make their services more available to people who are struggling financially, it is still classified as fraud and will be treated as such. 

5. Issuing Unnecessary Prescriptions

Prescriptions should only be issued in accordance with the relevant regulations and when they are medically necessary. However, addictions and the street value of prescription drugs mean that people have an incentive to falsify documents and access prescriptions illegally. This is a type of healthcare fraud that is sadly very common, despite strict protocols being put in place to try and prevent it. 

Healthcare Fraud Investigations

If you’ve been accused of healthcare fraud, you’ll want to obtain legal advice as quickly as possible. By choosing experienced attorneys, such as healthcarefraudgroup.com/, to represent you, you can ensure that you have access to specialist advice and representation. Although allegations of healthcare fraud aren’t uncommon, they are stressful and worrying. By getting the legal help you need, you can resolve the situation quickly, confidentially and effectively.

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