What is health care fraud?

In a perfect world, sick people would get the help they need, and no one would have to worry about the cost. The reality is, health care is a business. Like any business, a health care provider should expect reimbursement for providing their services.

There’s nothing wrong with pursuing what you’re entitled to through an insurance or Medicaid claim. However, a careless or inattentive approach could result in you facing charges of health care fraud.

What does health care fraud look like?

There are numerous examples of health care fraud. The majority of fraud-related cases involve the billing practices of a health care provider. Common examples of health care fraud include:

  • Billing for services not provided
  • Upcoding or charging for more expensive medical procedures
  • Waiving co-pays or deductibles in an effort to bill an insurance company more
  • Unbundling services or charging for separate steps involved in a medical procedure

Other forms of fraud have nothing to do with billing. Accepting payments for patient referrals is another common form of fraud.

Health care providers also need to be cautious of incentives offered by pharmaceutical companies and medical device manufacturers. There’s nothing wrong with relying on certain medications or diagnostic tools for the benefit of your patients. However, lines can be crossed if you start ordering unnecessary tests or prescribing medications that will have little benefit to your patients.

Fraud allegations often turn on intent, although honest mistakes can still lead to fraud charges. You should discuss your legal options with a skilled professional if you find yourself accused of health care fraud.

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