What is healthcare fraud and how you can prevent it from happening?

Healthcare fraud is a common occurrence in today’s times. Healthcare fraud is committed when a consumer or provider intentionally submits or causes another person to submit misleading or false information for use in the determination of the amount of heath care benefits that are payable. It is a crime that raises the cost of health care for the other people living in the society.

Healthcare fraud is unacceptable. It is just wrong. Nothing is right about inflating heath care bills to ensure that a bigger amount of benefits becomes available to a person than he has a right to. Here are some instances of provider health care fraud to help you better understand it:

• Billing for services which has not been used.
• Misrepresentation of procedures that are not covered by the insurance companies, such as showing cosmetic surgery as appendicitis operation.
• Unbundling or a process which shows the billing done for the different steps of the same procedure in a way that shows all the steps separately, thereby increasing the money payable.
• Waiving off the deductibles and patient co- pays and hence submitting a bill that overcharges the benefit plan or the insurance company.
• Making false diagnosis of a patient’s illnesses in order to justify the requirements of tests, procedures or surgeries that are not medically necessary.
• Upcoding or a process in which a procedure higher in price than what has been done on a patient is put on the bill.
• Billing a patient more than what the co- pay suggested and making her pay for services that were prepaid or even paid in full under the conditions of a managed care contract.

Following are examples of consumer health care fraud:

• Putting in claims for medical services that have not been received.
• Using another person’s insurance card or coverage.
• Altering or forging receipts or bills.

Following are tips on how to prevent and avoid health care fraud:

• Whenever a doctor or health care institution suggests procedures or services, ask why they are required and what they cost.
• When doing up claim forms, it is important that you do them one form at a time. Fill out and write the date to ensure that you don’t make any mistakes.
• Don’t trust free tests and promotions with a blind eye. There is every chance that they will make you pay through the nose. Why will anyone offer you anything for free? Instead whenever you are faced with such advertisements make sure you ask about the exact terms and conditions before signing.
• Do not give out your health card id or your insurance information to any medical institution unless you have volunteered to avail of the services offered. Misuse of such information is not unheard of.
• Be careful with who you give your health insurance information to. They reflect the benefits offered to you.
• If you suspect health care fraud by a provider or consumer, make sure you let the authorities know.