The common types of healthcare fraud and how to avoid them

Consideration was given for the editing and publication of this post.

Health care fraud is a serious and quite the prevalent problem ailing the medical system globally. To make sure you avoid getting duped, here is a complete guide to understand the frauds in the USA and how to prevent them from the legal experts at the Health Care Fraud Group.

Let us have a look at the types of fraud.

Dishonest billing services

Improper and false billing includes malpractices that are committed either by the theft of patient information or through falsification of data for services that weren’t performed.

Increasing the billing amount

Technically known as the process of “upcoding,” here the bill is made more expensive than what it actually should be. Inflation rates or an invalid procedure often accompany this kind of false billing.

Unnecessary medical services

Often unnecessary services are performed to generate profitable medical insurance and payments. This is prevalent for various diagnostic tests and services.

Misrepresentation of treatments

There are occasions where various non-covered treatments are misrepresented as covered and necessary treatments to increase the bill amount. Misrepresentation is highly common in the field of plastic and cosmetic surgery.

Falsification

Falsification of a patient’s diagnosis includes tests, surgeries, and medical procedures and their justification even though deemed unnecessary.

Unbundling

This occurs when each procedure and step for the treatment is treated as a separate procedure.

Kickbacks

Kickbacks from medical and pharmaceutical companies as well as for patient referrals are a form of medical malpractice that is quite prevalent.

Safeguard your insurance ID

Protecting the health insurance ID is essential, and you should exercise similar caution as you would for your precious credit cards. The same goes for policy numbers and make sure you are careful before making these details along with the insurance information public to the salespeople and the solicitors on the telephone. In case you suspect the theft of a card, let your service provider know of the predicament.

In case of fraud, do report

If you suspect that you have been subjected to medical fraud, then you have to report the scam to the responsible authorities. These days reports can be filed online as well.   

Be alert and informed

It is essential to be aware of all the healthcare services you require and receive along with maintenance of a record’s file so that you can reviews the bills as and when needed. 

Look through the fine print

Policy and medical benefits statements are laced with jargons and technical details. So, you must understand and read through the entire statement and policy papers. This includes the EOB or Explanation of Benefits statements and the associated paperwork as well in case of a medical emergency or requirement.

Avoid free offers

Free offers are often too good to be true, and this is why you should stay away from them. Free services are based on treatment schemes that are often fraudulent to dupe the insurance company off thousands of dollars.

Keep in mind that healthcare fraud is a serious crime, and it concerns everyone, from the top government official to the common tax-payer. Don’t overlook it; do your part for the benefit of everyone.