Understanding healthcare fraud by patients and doctors

On Behalf of | Jul 8, 2020 | Health Care Fraud

Doctors, physicians and other healthcare providers are often some of the most giving people in our economy. However, this is not always true. Healthcare fraud is a growing issue, both on the part of the patients and the providers. Studies have shown that 10 cents for every dollar spent in healthcare is going towards fraud.

Healthcare fraud is a white-collar crime. This means that it is nonviolent and for financial gain. It can come in many different forms. Here are some examples of healthcare fraud committed either by patients or doctors.

Patients committing fraud

When patients commit healthcare fraud, it is often with the intent to get prescriptions or treatment that would otherwise not be prescribed or to dodge or lessen payments. This type of fraud can include:

  • Using the identity and information of another
  • Forging a healthcare provider prescription
  • Using inaccurate insurance information
  • Loaning or using another’s insurance information
  • Using other false information

Doctors defrauding patients

When healthcare providers commit healthcare fraud, they are often placing the financial burden on the patient. Essentially, physicians may take advantage of the position of knowledge they have over patients and use it to make money. Here are some examples of healthcare fraud by doctors:

  • Providing and billing for unnecessary services, including prescriptions, testing and treatments
  • Duplicating services on a bill
  • Billing for services never performed
  • Billing people who are not alive
  • Altering information, including dates, services and identities
  • Billing uncovered services as covered by insurance
  • Incorrect diagnoses or procedures billed to raise costs
  • Selling prescription drugs
  • Changing medical records
  • Unlicensed staff use
  • Engaging in kickbacks for referrals
  • Waiving co-pays

If prosecuted, healthcare fraud can lead to time in prison, fines and revocation of medical licenses. However, there is a short window of 30 days in which insurance must pay healthcare claims, meaning that investigations often must also occur within that time, sometimes making it difficult to pursue.