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4 Common Types of Healthcare Fraud and How to Report Your Suspicions

5 months ago

3271  0
Posted on Apr 12, 2021, 6 p.m.

When you think of healthcare providers, you think of a trustworthy industry. In fact, there are a lot of dishonest companies out there who are committing fraud all the time, and costing people billions of dollars as a result. Healthcare fraud is actually one of the most common types of prosecuted crimes in all of the US.

So, what are the most common types of healthcare fraud? How can you avoid getting scammed, or report suspicions?

What is the Range and Scope of Healthcare Fraud?

There are some scary statistics out there. Fraud, waste, and abuse cost the US billions of dollars yearly. Did you know that in 2012, Medicaid and Medicare fraud cost the US nearly $100 billion?

This is happening all the time, and each procedure or interaction with an insurer can represent an opportunity for fraud for unscrupulous providers.

So how do you know what to look out for? What are the methods being used to defraud people?

4 Common Types of Healthcare Fraud:

Billing for Services Never Carried Out

Some healthcare providers will bill for appointments, treatments or even items that were never actually supplied. This can allow them to make money off insurance policies or privately. This method simply takes the money away from treatment and the medical industry and straight into the pocket of scammers.

“Unbundling”

This is when a medical organization charges more by charging individually for things that should be billed for all together. Hospitals might perform a lot of tests that should be paid for as one bundled price, but they may try to charge for each. This is like paying for every drink can in a multipack instead of getting a discount for buying 12 together!

Performing Services that Aren’t Required

This is another abuse of trust. Some medical professionals will tell clients they need services or medication that they don’t. Even if it doesn’t do them any harm medically, it is just a way to make money rather than to help a customer or a member of the public who needs assistance and has trusted them.

Upcoding

Upcoding is when healthcare providers charge more than they need to through subtly charging for items under a different code, or deliberately charging for more expensive procedures. This is an attempt to make money as fraud. While it is possible that a code can be put into a system correctly, it is certainly suspicious.

Tips for Avoiding Healthcare Fraud

How can you avoid healthcare fraud yourself? What are some ways in which you can do your bet and try to ensure that those performing the fraud are found out?

  • Use public records. There are a number of public records available to allow you to check an organization’s credentials, or even the background and legal history of an individual, such as a doctor or practitioner. A lot of these are simple to access online.
  • Ask for clear billing at all times. You need to be able to understand what you are paying for.
  • Get a second opinion on your need for treatment. This can ensure that you aren’t being asked to get a treatment that is superfluous.
  • Check reviews and testimonials. Like any industry, the healthcare industry has to be accountable when it comes to reviews and online feedback. Check the reputation that a doctor has before you go ahead and get treatment from them.

Conclusion

If you think that a healthcare professional might be acting unprofessionally, you can report it to the FCA. They have qui tam programs that even allow people to share what they know and get rewarded if there is a settlement. This is to encourage people to share what they know. This means that even employees of the fraudulent organizations might come forward.

Sadly, healthcare fraud continues to be an issue, but by recognizing the sort of problems it can cause, you can hopefully avoid issues happening to you directly. Even if the “target” is your insurance company rather than you as an individual, you should realize that we all pay for this in one way or another. Fraud leads to increased premiums for everyone when taking out an insurance policy.

This article is courtesy of Ben who is a Web Operations Executive at InfoTracer who takes a wide view of the whole system. He authors guides on entire security posture, both physical and cyber. Enjoys sharing the best practices and does it the right way!

As with anything you read on the internet, this article should not be construed as medical advice; please talk to your doctor or primary care provider before making any changes to your wellness routine.

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Content may be edited for style and length.

This article is not intended to provide medical diagnosis, advice, treatment, or endorsement.

https://www.forbes.com/sites/merrillmatthews/2012/05/31/medicare-and-medicaid-fraud-is-costing-taxpayers-billions/?sh=aa57eec73311

https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Downloads/infograph-There-Are-Many-Types-Medicaid-Fraud-%5BMay-2016%5D.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5419025/

https://infotracer.com/

https://www.idstrong.com/sentinel/health-care-fraud/

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