What constitutes health care fraud?

On Behalf of | Apr 27, 2017 | blog, Firm News

If you work in the medical field, you are probably familiar with the term “health care fraud,” but you may be less familiar with what it means exactly and what type of actions constitute this type of crime. Generally speaking, health care fraud is an umbrella term used to describe a health care provider’s efforts to deceive or misrepresent insurers or government entities for financial gain.

While there are countless examples of actions and behaviors that may be considered health care fraud, learning to recognize some common examples may help you avoid making any missteps that may land you in considerable trouble. These are common examples of health care fraud.

Billing for services, treatments or procedures that never take place

If you bill an insurance provider or government health care program for a procedure, and that procedure never took place, this may be health care fraud. If you do the same for certain treatments and then never actually perform the procedure for whatever reason, you may also be guilty of health care fraud.

Adding inaccurate dates and costs to patient records of service

In the medical field, accuracy matters. Recording the wrong date for a listed procedure may seem like a minor slipup, but such an error can also constitute health care fraud. Another example is billing the insurance company or government health care program for a costlier procedure than the one you actually perform.

Providing unnecessary services

You may also face allegations of health care fraud if you perform an unnecessary surgery, treatment or procedure without due medical cause. Fraud occurs if you provide a patient with a treatment that he or she does not medically need to make a profit.

Listing inaccurate diagnoses or conditions needing treatment

A medical record is no place for guessing. If you report any condition other than the one treated, or record any course of treatment other than the one performed, you may be guilty of committing health care fraud.

If you face allegations that you engaged in health care fraud, you may find it beneficial to speak with an attorney.