Health care fraud is similar to any other fraud. The goal is to take advantage of others and gain profit from the act committed. Health care fraudsters can be anyone. It can be health care providers, patients, employers, insurance companies, and suppliers. However, what makes it enticing to commit fraud in health care is because it offers huge, easy money to anyone willing to do so.
According to expert lawyers, like those from the Healthcare Fraud Law Group, investigating health care fraud proves to be challenging yet satisfying. Fraudsters bend facts to go along with their schemes. While there are cases where patients get involved in fraud to lessen their expenses, health care providers still have a higher chance of committing one.
Here are the top five health care fraud schemes that you should know to avoid getting duped.
#1: Billing For Services That Are Not Given
According to studies and surveys, billing for health care services not rendered is one of the most common schemes of health care fraud. A health care provider may submit claims to the government health support plans or medical insurance companies to seek payment. More often than not, these fraud claims do not have supporting documentation. Providers input codes and extra information on the claim sheet in the hopes of scoring some quick cash.
#2: Billing For Services Not Covered by Insurance Companies as a Covered Service
With a few edits on the procedure information, a health care fraudster can file claims for a treatment that has no approval from insurance companies. Some change the codes, while others use other procedure names to make it more believable. Sadly, some patients connive with health care providers as treatment expenses are usually high.
#3: Altering the Service Dates
Health care providers generate more income when they report two treatment dates for a single patient rather than one full day. It is because every patient visit can be billed separately. Patients receive the treatment, but health care fraudsters place different dates on claim forms to gain more profit from insurance companies.
#4: Changing the Service Location
Patients sometimes need to go to different locations for various procedures under one diagnosis. Health care fraudsters take advantage of that. Some providers claim that they did the treatment to one patient when what they did was to instruct the patient to do it at home. The lack of supporting documents creates a red alert to insurance companies to claims like these.
#5: Service Provider Misrepresentation
Another health care fraud scheme is when a licensed medical professional signs a claim form asking payment for a procedure that a non-licensed staff performed. If there would be no investigation, an insurance company would have paid for the procedure. However, more often than not, the inconsistencies with the description and coding alert insurance companies that it may be a case of fraud.
According to experts from the Healthcare Fraud Law Group, anyone may be a victim of fraud. The key to preventing a fraudster from gaining profit from unjust claims is to educate yourself with the possible schemes that might happen. Seek supporting documents and understand the importance of procedure description and coding. Insurance companies and medical providers alike are using AI to combat possible fraud. You have to be wary and alert of these schemes in the future to avoid being victimized by health care fraud.