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6 Most Common Health Care Frauds
Deception in the business of Health Care providing has become an increasingly prominent threat. Get familiar with the most common types of fraud, know what questions to ask, and schedule a criminal attorney San Diego free consultation immediately.
Billing for items or services not furnished
A straightforward fraud on the part of the provider of healthcare. It comes in various forms, so there are many ways for the unscrupulous provider to divert funds from the healthcare beneficiary.
Most common versions of this fraud include billing for appointments that never happened, or billing for medical devices not supplied by the doctor. If you have a reason to think this happened to you, it is a good idea to arrange a criminal attorney San Diego free consultation and inquire about the next step.
Upcoding
This is the process of healthcare providers trying to bill the patients for services or products that are more expensive and more complex that the ones that have actually been provided. There is always a possibility of this happening by accident, but more often, it’s intentional.
A common example is opting for a more expensive and invasive procedure, in place of an equally effective, but less complicated and cheaper one. In order to avoid this extremely tricky fraud, try asking for second opinions before making a decision about the procedure.
Unbundling
In order to maximize the profit, a service provider can attempt to bill a patient in a fragmented manner. It means increasing reimbursement for procedures or tests that should be billed as one by dividing them.
A usual type of this fraud is present when performing blood panel tests. While the cost of the entire panel should be under a single bill, the lab might attempt to increase profit by individually billing each test. If you pick the right lawyer, it is a fraud easily rectified after a criminal attorney San Diego free consultation.
Unnecessary services
This is probably the most unscrupulous example of just how far certain healthcare providers are willing to go for some extra profit. It involves unnecessary services and procedures on patients for unlawful financial gain.
One of the most extreme cases is from 2015, when a doctor received a 45-year prison sentence for chemotherapy treatment of patients who were cancer free.
The usual instances of this fraud are not so severe. For example, a surgeon might suggest an invasive knee surgery before exploring other options. This presents an enormous trust abuse, increases the patient’s bill significantly, and is a breach of the doctor’s ethics.
Doctor shopping
This one is on the patients. It is a practice of patients visiting several doctors to obtain more than one dose of a controlled substance. The drugs obtained are either distributed to others for illegal financial profit, or overused by the patient.
There are measures that providers take in order to limit doctor shopping, but there are also providers with no safeguards in place. This remains a substantial issue that cannot be resolved easily without joint efforts on part of both the providers and the beneficiaries.
Identity theft
The occurrence of identity thefts in order to reap the benefits of medical insurance has become increasingly prominent since the digitization of PHI – personal health information.
The percentage of medical identity theft has risen to 21% in the last year, costing the afflicted person $13,500 on average to fix. Criminal attorney San Diego free consultations always help, but the costs are still great.
In need of a criminal attorney San Diego free consultation? Look no further!
Vik Monder of Monder Criminal Lawyer Group is the leading expert in the field of criminal law. His integrity, honesty, as well as his impeccable record make him the most sought-after criminal attorney in the San Diego area. Attorney Monder provides free consultations, so feel free to contact him if you have been involved in a healthcare-related fraud issue.
