Health care fraud schemes and examples

On Behalf of | Aug 1, 2020 | Health Care Fraud

Health care fraud leads to billions of dollars in losses across America. Depending on how the cases play out, the patient might even suffer harm in the commission of this act. While a lot of the focus is often on patients or even strangers committing health care fraud, doctors might do so too.

When doctors commit fraud, it helps to bring more money into the facility. The patient is even less likely to notice if the health insurance company covers the full bill. With insurance companies feeling the financial squeeze of this, many have stepped up to help fight health care fraud.

Health care fraud schemes

There some specific and organized schemes health care facilities might resort to when engaging in health care fraud. According to the FBI, these are two of the most common:

Medicare Fraud: Doctors sign off on expensive medical products that patients do not need.

Rolling Lab: Health care providers visit retirement homes, health clubs and even shopping malls to administer fake or unnecessary tests.

Health care fraud examples

Cigna states that only a small fraction of health care providers ever engage in health care fraud activities. These are some common examples it identifies:

  • Billing each step or stage of one procedure separately to increase the cost
  • Billing for more expensive procedures than the ones that took place
  • Falsifying diagnoses and even performing unnecessary procedures
  • Billing patients for some of the amount already paid by the insurance company
  • Billing patients higher co-pay amounts than instructed by the insurance company

Health care fraud is a federal crime and can fall within the jurisdiction of the FBI. The FBI also cooperates with insurance companies and several other organizations to bring responsible parties to justice.