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What Is Health Care Fraud?

What Is Health Care Fraud?

Health care fraud, simply put, is when either a provider or consumer causes false or misleading information to be submitted to determine what health care benefits will be paid. While only a few people actually commit healthcare fraud, it raises costs for everyone.

How to Identify Health Care Fraud

Health care fraud comes in many different forms. For the consumer, they include:

– using a coverage plan or ID card that isn’t yours

– altering bills, receipts, or other forms

– forging bills, receipts, etc.

– filing claims for medications and services that haven’t been received.

For a provider, the forms of fraud include:

– billing a customer for a service that will not be performed

– billing for a service that was worth more than what was actually given

– billing for each stage of a procedure, for instance, making one procedure that is four steps worth four procedures

– waiving co-pays/deductibles

– overbilling insurance or benefit plan

– billing for more than the co-pay for services prepaid or paid in full by the plan.

Avoiding Health Care Fraud

While the forms might not be incredibly easy to identify, there are things to look for. Avoiding health care fraud can include:

– filling out one claim at a time

– question the services you receive (why are they needed, what will they cost, etc.)

– compare the services you receive with the plan and your medical records (are they correct? were they actually given to you?)

– question any charges exceeding the co-payment you pay as defined as your provider

– give a call to local health care providers to report suspected fraud.

Know When to Get Help: Contact the Khonsari Law Group

White collar crimes such as health care fraud can result in some serious damages. The best course of action is to hire a professional and experienced attorney who will vigorously fight on your behalf. Contact the Khonsari Law Group today.

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