What is phantom billing?

On Behalf of | Jan 6, 2023 | Firm News

Doctors and medical professionals in the New York area know that health care fraud charges carry serious penalties, including major fines, jail time and loss of a medical license.

The problem is that the health care industry is extremely complex. Along with providing the best possible care to their patients, doctors are responsible for making sure their staff is submitting claims to insurance companies correctly and complying with the numerous federal health care laws.

If mistakes are made during this process, doctors could find themselves accused of fraud. There are many types of health care fraud, and one of the most common is phantom billing.

Submitting claims for services never performed

Phantom billing is submitting a claim to health insurance companies on behalf of current patients for services that were never rendered or even on behalf of former patients who are now deceased.

The point of phantom billing is to get the insurance company to pay for these non-existent services, increasing the doctor or health care providers’ profits.

Since no patients are harmed, some may think that phantom billing is not a serious crime. However, the federal government takes it extremely seriously.

Phantom billing is not a victimless crime

Phantom billing indirectly harms patients because the more health insurance companies pay out, the more it costs them to provide health insurance. This results in charging patients more to receive health insurance.

Even if you are not the one directly profiting from phantom billing, or did not even know the practice was happening, you could still find yourself involved in a phantom billing investigation.

The insurance company or the federal government can initiate an investigation and potentially bring fraud charges against you and anyone else they believe had a role in the fraud.

There are potential defenses available to health care fraud charges for phantom billing. However, it is important to learn about phantom billing and how to prevent it, since even just a fraud accusation can damage your career and reputation.