Healthcare fraud schemes hurt patients, insurance providers and government health care programs, but they are not always easy to recognize. Healthcare invoices are often complex and difficult for patients to understand, and the confusing nature of the insurance claim process may make it harder for individuals to recognize fraudulent charges.
Understanding the signs of common healthcare fraud schemes may help patients and insurance providers protect themselves from financial loss.
Common features of healthcare fraud schemes
According to the FBI, healthcare fraud may include false insurance claims, unnecessary tests and unneeded medical equipment. For example, a doctor may charge a patient’s insurance company for a procedure that he or she never provided to the patient. A healthcare provider may also give a patient a piece of medical equipment and claim that it is a free product but also send a bill to the patient’s insurer.
A similar type of fraud involves medical personnel providing unnecessary tests to individuals and then sending bills for those tests to insurance providers. The FBI states that these “rolling lab” schemes often occur at retirement homes or health clubs.
Signs of possible Medicare fraud
The Medicare organization is a frequent target of healthcare fraud schemes. According to Medicare.gov, one possible sign of a fraud scheme is a discrepancy between a patient’s medical receipt and his or her Medicare statement. A patient’s Medicare statement includes a detailed list of services, treatments and/or prescriptions. If a patient finds services or medications on his or her Medicare statement that he or she never received, it could be a sign of fraud. The Medicare website includes instructions for reporting suspected fraud and encourages patients to do so, especially if they receive Medicare claims that list unknown healthcare providers.