While health care providers are charged with providing the utmost care for their patients, there are a select few that opt for defrauding the system. As the years go by, some companies are formulating new ways to scam the health care insurance industry. Here are some of the most popularly used methods so that you can use this information to create a viable defense for your case.
Services not rendered
The most commonly used scam in the health care industry is billing for services that a provider didn’t render. When a medical facility submits claim forms to a health care insurance company for care or services that were never provided, the offending party could be liable for jail time.
It’s not uncommon for mistakes to be made when filing claims with an insurance company. You may have billed for a service that the patient canceled. Usually, these claims can be quickly resolved by identifying the mistake.
Billing for a non-covered service as one that is covered
Whether done to protect the financial well-being of a patient or to utilize treatments that aren’t yet approved by health care insurance companies, medical facilities sometimes bill non-covered services under a covered service code. Any provider who is willingly changing the code to represent a covered service for one that is clearly not covered is considered as committing fraud. It’s a health care provider’s job to only bill for services that are covered by an insurance plan.
The health care insurance industry can be very complex for any medical facility. While you may not intentionally do so, fraud does happen. Understanding what is considered fraud can help you to formulate a better plan in the future to avoid committing unintentional fraud. Seeking the help of a lawyer if you’ve been charged with health care fraud may be beneficial for better understanding and defending your case.