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Understanding health care provider fraud schemes

On Behalf of | Jan 31, 2023 | Health Care Crimes |

Health care fraud occurs when medical professionals use an intentional act of deception to benefit financially. This type of fraud often receives investigation from both state and federal law enforcement agencies. To protect yourself against accusations as a Florida medical provider, you should be aware of the most common types of fraud in the industry.

Fraud types involving services

Many types of health care fraud involve the misrepresentation of the services provided by medical professionals. Common examples of this type of fraud may involve:

  • Misrepresenting dates or lengths of services
  • Incorrectly listing the location of provided services
  • Misrepresenting the service provider
  • Incorrect charting or reporting related to procedures or diagnosis
  • Unnecessary or excessive prescriptions

Common billing fraud

One of the most common ways for health care providers to commit fraud involves incorrect billing practices. These practices may include any of the following:

  • Sending bills for services that were not provided
  • Charging Medicaid for unrelated expenses
  • Charing double for a service
  • Upcoding the type of care provided
  • Waiving deductibles
  • Performing a non-covered service and charging it as a covered service

Common types of providers

Although you may immediately think of doctors when you hear the term “healthcare fraud,” other providers can face charges. In addition to physicians, the most common health care providers accused of fraud include:

  • Hospitals
  • Long-term care facilities
  • Therapists
  • Laboratories
  • Managed health-care organizations
  • Pharmacists
  • Transport companies

Penalties for providers committing fraud

The penalties depend on whether you are facing state or federal charges. You will also face increased prison time and fines if someone obtains an injury because of your fraud. Health care fraud can result in up to 20 years in prison, and you can lose your professional license.

Most health care professionals provide honest care. To prevent fraud accusations, ensure your billing and charting remain accurate to the care you provide.