Playing Your Part To Help Combat Healthcare Fraud
When it comes to healthcare fraud it is pretty apparent that this is a crime that pays and pays. The federal government has admitted that in excess of 60 billion dollars is fleeced from taxpayers through Medicare scams alone every year. Fraudulent clinics, pharmacies and medical supply companies are popping up all over the country and people from former drug dealers to clerks are creating their own individual scams to extract millions of dollars every year from healthcare providers and insurance companies. The victims are the country's taxpayers.
How is healthcare fraud committed?
Healthcare fraud is a general term that refers to a corporation or an individual seeking financial reimbursement from a healthcare provider, such as Medicare, under false pretences. There are many different types of fraud within the health sector but they all have the same goal, which is to collect money from the health provider illegally.
Whichever way you look at it, healthcare fraud is unacceptable. It is totally wrong for someone to profit from actions that cause inflated health bills and in some cases can endanger lives. Just so you understand the type of actions being referred to, here are some examples:
- billing for services which were not provided
- falsely diagnosing a patient's illness in order to justify the need for various tests, medicines or surgeries which are not medically necessary
- submitting a bill which overcharges a benefits plan or the insurance company by deliberately failing to take into account patient co-pays and deductibles
- intentionally misrepresenting a surgery that is not covered by the insurance companies such as showing cosmetic surgery as an appendicitis operation
- billing for a procedure which is more costly than that which the patient actually received, a process known as upcoding
- billing in excess of what the co-pay suggests and forcing the patient to pay for services that were already pre-paid or in some cases paid in full under the conditions of a managed care contract
- billing for each individual step of a procedure which results in a higher cost than the cost of the complete process
Examples relating to consumer health fraud include:
- using another person's insurance card or coverage
- altering or forging bills or receipts
- putting in a claim for a medical service that was not received
Tips to help you prevent and avoid medical healthcare fraud
- Do not give out your healthcare id or your insurance information to any form of medical institution unless you have previously decided to use their services. Misuse of this information is not uncommon.
- If a doctor or healthcare provider suggests certain tests or procedures, be sure to ask exactly what they are for and how much they cost,
- Be wary of any so-called 'free' tests or procedures. Treat them with caution since when did anyone offer anything for free! You may find yourself paying through the nose further down the line. Before signing up for any free or special offers always make sure you understand the terms and conditions stipulated in the small print.
- When completing claim forms take your time and do them one at a time, being sure to put in the date on each one.
- Be careful whom you give your health care insurance information to since this details all of the benefits available to you.
- If you suspect that something is not quite right and above board, then don't hesitate to let the relevant authorities know.
The government does have one weapon to use against fraudsters and that is to bring in the 'qui tam' law. Under this law the government offers incentives for whistleblowers to report any wrongful doings. If you have any information relating to a healthcare fraud or a healthcare insurance scam, then by contacting an experience attorney, you may be able to put a stop to this action and be financially rewarded for doing the right thing.
