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What Is Health Care Fraud? November 24, 2019

Health care companies receive millions, if not billions, of health insurance claims for affordable and quality care. It has been revealed that a small percentage of these annual claims are fraudulent. However small the fraudulent claims, the government loses lots of money because of it. This criminal offense is the reason for the rise of health care fraud attorneys.

Who commits health care fraud?

A majority of health care plan holders and health care providers are culpable. Examples of health care providers are dentists, doctors, pharmacies, and the likes. Even worse, people who willingly give out their insurance information may fall victim of health care fraud since their identity has been compromised. Such individuals may hire a health care lawyer if they are innocent. Check here!

Types of health care fraud

As health care fraud involves dishonest individuals, culprits are likely to devise many ways to commit this crime. From hacking into medical records to duplicating procedures and submitting false claims, health care fraud varies in type.

The NHCAA, an acronym for National Health Care Anti-Fraud Association, categorizes health care fraud accordingly:

Health care providers commit frauds through:

  • Fraudulent medical billing, especially overcharging for excess services
  • Phantom billing – Billing medical procedures that were not performed
  • Prescription drug fraud – Concocting false diagnosis to justify unnecessary tests
  • Upcoding – Misrepresenting covered procedures as uncovered ones

Patients commit frauds when they:

  • Fill claims for prescriptions or medical procedures they didn’t receive
  • Forge health care bills to get reimbursements
  • Falsify their identity by using a fake insurance card
  • Peddle prescription drugs

Penalties and consequences of health care fraud

Health care fraud attorneys, according to the Health Insurance Portability and Accountability Act (HIPAA), may regulate the consequences of violating health care insurance claims. By confirming the criminality of the act, the HIPAA will prosecute offenders accordingly. If found guilty, the offender could face drastic consequences ranging from substantial fines to jail time. If the crime has led to the death of a patient, the offender may serve life imprisonment in federal prison. Other penalties include probation, loss of medical license, criminal charges, and seizure of assets, to mention a few.

Avoiding health care fraud

It is pertinent to prevent health care fraud since naivety is not an excuse in the court of law. A cankerworm in health care infrastructure, big agencies such as the FBI and FDA are adequately cracking down on health care fraud. Hence, everyone must avoid it by carrying out the following:

  • Stay informed – You must be aware of every medical procedure you’re entitled to, and document procedures for future purposes.
  • Protect health care credentials – Safeguarding your ID starts with preventing the illegal use of your insurance cards. Since your identity can be used to seek medical services and peddle prescription drugs on the internet, you have to ensure your card is protected at all times.
  • Report fraud – If, at any point in time, you detect fraudulent health care activities, inform your health insurance provider immediately. And endeavor to report card or identity theft to law enforcement officials, as well.

Sometimes, health care frauds are difficult to understand without proper guidance. In case you’re suspicious of a scam, a health care fraud attorney or health care fraud lawyer can represent you in court. Click here for more information: https://smallbusiness.chron.com/concept-fraud-healthcare-industry-71970.html