Hospital Fraud: 11 Types of Medical Fraud You Don’t Want to Get Busted For
The medical profession has grown into a mammoth multi trillion dollar industry in the United States. Government funded medical insurance programs like Medicare and Medicaid provide a rich source of medical fraud and abuse cases. Although the vast majority of health care providers are honest and forthright in their billing practices, the temptation to commit medical fraud is substantial.
You don’t even have to be a crook to get in trouble with government regulators. The Medicare and Medicaid regulations are so voluminous and difficult to interpret that honest mistakes are commonplace. Federal and state regulatory agencies expend millions of dollars every year to reign in fraudulent billing practices.
The other side of the medical care industry is the vast repertoire of schemes that are employed to pillage the public treasury. Believe it or not, gathering a group of patients around a television might be billed as professional group therapy. It’s easy to see how the whole thing could get out of hand.
Medical health care providers, consumers, suppliers and venders have all contributed to the rising incidence of fraud and abuse. Even computer hackers and organized crime syndicates have gotten in on the act. The following is a brief sample of the illegal billing practices that investigators discover every day:
- Billing the government for services or supplies that were never actually provided
- Misrepresenting the dates that services were provided
- Billing for non-covered treatments, services or supplies
- Misrepresenting the facilities where services were provided
- Waiving patient co-payments and deductibles
- Misrepresenting the provider that rendered a service or treatment
- Unnecessary provision of services or treatments
- Bribery and kickback schemes
- Prescribing drugs unnecessarily
- Inaccurate reporting of patient diagnoses and procedures
- Providing unnecessary treatments, procedures or services
The expansion of government funded health care services in the United States has led to an increase in medical fraud and abuse. The recently enacted Affordable Care Act expects to provide medical insurance for more than 20 million Americans. When combined with other publicly financed health care programs, the amount of money involved is simply staggering. One can only imagine the number of electronic billing statements that are submitted to state and federal agencies every year.
Unfortunately, many health care providers have to face criminal charges for defrauding the government. Nursing homes, hospitals, ambulance companies and other health care providers may have to defend themselves in court to avoid the harsh reality of a criminal conviction for medical fraud.
White collar crimes like medical fraud are sometimes difficult to investigate and defend. Specific experience concerning government regulatory practices and procedures is an absolute necessity. Regulatory rule changes are commonplace and the sheer volume of information involved is tedious and time consuming to unravel.