Common types of health care fraud

On Behalf of | Sep 19, 2022 | Health Care Fraud

As a medical professional, you always seek to provide competent care on a physical level. But you are also in the business of making money, and it can be easy to overstep boundaries in this field. Sometimes, through intentional or unintentional overreach, you could find yourself facing accusations of health care fraud.

Four types of health care fraud

Most health care fraud is at the hands of individual physicians or medical offices. Health care fraud can take numerous forms. The following are some common forms of health care fraud.

Sometimes a physician or medical office bills a patient for services they never received. These may be real patients of the practitioner, or they may be people whose personal information was stolen and then billed as if they were legitimate patients.

In a practice referred to as “upcoding,” a physician or medical office bills a patient for more costly care than the patient actually received. To do this, the physician or medical office will inflate the patient’s diagnosis in their billing system to a more serious and more costly one.

Another type of health care fraud is “unbundling.” This occurs when a patient is billed for each individual part of the procedure performed. The goal is to make these parts look like they were each a separate procedure with separate charges leading to an inflated bill.

Sometimes doctors take kickbacks for referring patients to other physicians or medical facilities. Accepting kickbacks is another form of health care fraud and it is illegal.

Health care fraud charges can be challenging to fight

If you are accused of health care fraud, you may be facing an uphill battle. Health care fraud claims are brought via the False Claims Act, in which people are incentivized to bring forward claims of potential health care fraud to the government. This makes health care fraud cases challenging. However, working with a legal professional experienced in this area of law can make a world of difference to the outcome of your case.