Healthcare Fraud

Most popular health care frauds

Health care employees are looked at as one of the noblest people by many. But don’t be fooled. Even though many of the medical providers are honest and do a good job in improving our health, there are still the ones that are looking at us through the eyes of fraudsters, and they are just waiting for the opportunity to get their hands on some free money, where we, and our health problems represent the perfect means. Fraud in health care is just like in any other industry: Fraudsters with the means and opportunity take full advantage to unjustly profit. Health care crooks inside and outside the industry include patients, payers, employers, vendors and suppliers, and providers, including pharmacists. Organized crime rings and computer hackers also play roles in committing health care fraud. What are some of the most popular health care frauds? Find out in the following!

Change the code and non-covered service becomes covered

Charging non covered services as covered services is one of the most common frauds in health care. Here is how it plays of. Say an allergy doctor wants to treat his patients with an experimental drug that hasn’t been approved by government health care plans or other insurance companies. With just a few strokes of pen the allergy doctor can submit claim forms and still get paid for utilizing the experimental treatment. It is that simple, the doctor can just code the drug differently and call it something else that is covered by insurance plans and policies. The doctors who get caught rationalize their wrongful actions by saying they believed they were providing a useful service to their patients who were actually their guinea pigs that helped them in testing new and unapproved drugs that could cause lots more damage than good.

Your insurance pays for something you do yourself

Health care fraudsters go as far as misrepresenting locations of service. In one clinic, during the period of treatment, the patients were given a bunch of syringes filled with antigens and they were told to inject it themselves in their homes. Now, as horrible as this sounds, it is nothing uncommon. The uncommon thing is that health care providers in this clinic billed the service of injecting those syringes themselves to the insurance companies of their patients. They were just submitting claim forms on injecting their patients with the antigens from Monday through Friday in the clinic facilities. Besides billing for the service they haven’t done, this way they protected themselves with the medical files in case if the patient forgets to inject himself and the treatment fails so he decides to sue them.

Severe diagnosis for a bigger bill

Listing an incorrect diagnosis or procedure can be compared to a scheme in a repair industry of any kind. Say if you go to an auto repair shop, you must know that simple change of oil in your car is much less expensive then the complete car check up. Unscrupulous providers can bill for extra services if they report false serious diagnoses or procedures performed. For example, if an elderly patient reportedly fell inside a nursing home, a crooked provider could intentionally misdiagnose her with head trauma requiring the (unnecessary) use of a computed tomography (CT) scan and/or blood tests. This example is just a mild one of what is being done. Some diagnoses require longer, more expensive hospital stays. There are numerous examples of patients who suddenly and mysteriously got better as soon as their insurance coverage ran out. We have only listed three of some of the most common frauds in health care industry, but like in all spheres of life, there are so many more. The important thing is to recognize them and not get scammed. The scheme descriptions in this article will get you started in learning how to battle this scourge, help victims and reduce soaring health care costs.