As a doctor you took an oath to do no harm to patients. While it is understandable that this oath includes avoiding causing patients physical harm, patients can also be financially harmed if their doctor commits healthcare fraud. While many times healthcare fraud can be attributed to honest errors, it is good to understand the various types of healthcare fraud that could occur.
Common types of healthcare fraud
One type of healthcare fraud involves billing patients for services that were never provided. A doctor may use a patient’s information to fabricate a claim for services that never occurred or bolster an otherwise legitimate claim for services that never occurred.
A second type of healthcare fraud is “upcoding” or billing for more expensive services than what was provided. This includes replacing a patient’s diagnosis code with one that is more serious that would necessitate the false, higher-priced treatment.
A third type of healthcare fraud is misrepresenting what treatments are necessary. This includes claiming treatments that are not covered by a patient’s insurance are necessary when they are not. Cosmetic surgery schemes are a common example of treatments that a physician would claim are necessary when they are not.
A fourth type of healthcare fraud includes purposely falsifying a patient’s diagnosis in order to justify treatments that are actually not needed. A fifth type of healthcare fraud includes charging patients for each step of a single procedure as if these steps were separate procedures. This is referred to as “unbundling.”
A sixth type of healthcare fraud includes billing patients for more than what they owe as a co-pay for services that would have been prepaid or paid-in-full by the patient’s insurance. A seventh type of healthcare fraud includes taking kickbacks for referrals.
Healthcare fraud impacts innocent doctors
Healthcare fraud impacts patients in a variety of ways — it is not a victimless crime. Still, many physicians simply make honest mistakes and do not deserve to be labeled as “dirty doctors.” If you are being accused of committing healthcare fraud when in reality you never intended to defraud patients, you will want to learn more about your defense options.