Health care fraud is a white-collar crime committed by someone in the health care business. The health care industry has been the target of many scams, from medical identity theft to Medicare fraud, so understanding health care fraud is important for everyone, especially those charged with it. The common types of health care fraud schemes include the following.
In some cases, health care providers bill for the same service multiple times. For example, a health care provider might bill Medicare for a service and then bill the patient for the same service.
Unbundling is when health care providers charge for services that are part of a single procedure or treatment; they unbundle them to charge the patient more than once. For example, if you need an MRI done on your knee and shoulder at the same time, health care providers might bill you separately for each body part.
Misrepresentation of services
Sometimes, health care providers misrepresent the services they provide in order to increase their profits, which amounts to health care fraud. For example, health care providers might overstate the length of a procedure or service to get reimbursed for more than they actually provided.
Misrepresentation of fact
It’s not uncommon for health care providers or Medicaid recipients to use deception or misrepresentation in order to receive unwarranted medical benefits from Medicaid. In some cases, recipients may lie about their income or household composition in order to qualify for benefits they don’t qualify for. In other cases, health care providers may inflate the amount of work they do or overbill Medicaid for services they never provided.
There are many types of health care fraud other than those above, but these are the most common. It’s important for everyone involved in the health care industry to understand these schemes and take the right steps to correct them if they do happen.