What are the three most common forms of medical billing fraud?

On Behalf of | Apr 26, 2022 | Health Care Fraud

Health care fraud occurs everywhere, including the New York City metro area. There are three forms of medical billing fraud that are the most common.

What is medical billing fraud?

Medical billing fraud is a type of fraud that occurs when a health care provider deliberately and willingly files false and manipulated claims. The purpose behind this illegal activity is so that the health care provider can gain more money for services that were not provided or for services that were not as extensive as claimed.

This type of fraud costs a lot of money lost to individuals and the government every year.

What are common forms of medical billing fraud?

Certain types of medical billing fraud are more common than others. Upcoding is a type of billing fraud that happens when a patient goes to a doctor’s office, hospital or another medical facility for treatment. However, instead of billing for the exact services or treatment rendered, upcoding involves billing for more than what the patient received.

Phantom billing is a type of medical billing fraud that involves billing for services that were never performed. Fabricating services is one of the worst forms of fraud as it can raise the costs of health care each year. In addition to hurting the government by costing it significant money, it also hurts patients. Phantom billing can show up on the patient’s records and affect their insurance even though they had nothing to do with the fraud that was carried out.

Service unbundling is a form of medical billing fraud where procedures that are meant to be included in one billing are billed separately. This is done to create a larger bill in the invoice. Patients on Medicaid and Medicare are the ones who hurt the most from this fraudulent practice.

A charge of medical billing fraud is serious. If you made an honest mistake, you have the right to fight back against the charge.