Cunning health care providers usually commit fraud, and in some unfortunate cases, most are pretending to be a legitimate health care provider. This has tarnished the reputation of the respected and trusted individuals in the medical field. They take advantage of the trust people give them to commit massive fraud on a broad scale. These people have the audacity of being creative due to the options available to come up with all sorts of fraudulent activities.

Sadly, in 2018, fraudulent health insurance claims were $3.6 trillion in the United States. Though, these are only considered as a small fraction of what’s out there as tens of billions dollar each year is lost, according to the National Health Care Anti-Fraud Association (NHCAA). It carries the burden of having an impact on the integrity and perception of the public regarding the health care system. Here are some other ways to tell how if you’re experiencing medical scams:

Medical Services That Wasn’t Provided

Some health care providers or their hospitals submit claims to insurance companies and the government for medical services that weren’t provided and items that aren’t distributed at all. What’s worse is the patient not having any supporting documents for it.

It’s best to request an itemized bill as you are entitled to have one. This contains all of the necessary and relevant amounts that you need to pay. Asking for one will help you avoid unnecessary costs, therefore, calling the billing department for a full detailed statement will be beneficial.

Billed for Covered Service for a Non-Covered Service

Health care providers may suggest or perform treatments that aren’t covered by your health care insurance companies. These are services that aren’t reimbursable by an insurance company or even the government. Health care providers try to acquire reimbursement for the non-covered services by falsely labelling it as covered medical services. In short, some medical services are not covered, and most people are charged without knowing at all. 

Falsifying Dates of Service

Health care providers may manipulate dates of services and may even add extra appointments that weren’t taken in the first place. Increasing the number of appointments is only going to add more fees. Assure that the medical documents of the patient match the dates of the services provided listed on the claim forms.

Emphasize the” date of service” instead of when the claims form was signed and submitted. The dates are likely to be days after medical assistance was provided if it’s a fraudulent case. Fraudsters do this as a way of utilizing profit as each day of a patient’s” visit” can be billed separately.  

Dishonest Regarding the Location of Service

There are times that health care providers do home services for their patients. Fraudulent doctors will report these instances as it has been done at their clinic. In short, they don’t correctly specify where the service was done when asking for reimbursements. These are usually inaccurately coded since the medical services were done in a non-facility location.

Though some health care providers aren’t aware that this kind of billing is inappropriate and illegal, however, some do this to inflate the costs for the medical service through an unnecessary overpayment.

Durable Medical Equipment Fraud

Durable Medical Equipment (DME) companies usually provide helpful services by giving a variety of health care equipment. Nevertheless, many fraudulent companies have appeared.

One of the examples of durable medical equipment fraud is when a fraudulent DME company partner with a fraudulent health care provider or uses a stolen identity of a physician to validate medically that a beneficiary needs medical supplies. However, they are billed without even receiving any actual equipment.

Practicing Without a License

Due to the trust that the patients give their doctors, practicing medicine without a license is significantly happening. These can range from practicing medicine without any relevant training with criminal intent like fraud or even inflict sexual assault. They may also charge more for something they didn’t have any proper medical training. Hospitals and clinics may unknowingly hire inexperienced doctors to administer treatments due to fabricated credentials.

Laws may vary regarding this but practicing without a license is illegal. Sentences differ depending on if it’s a felony or a misdemeanor offense, and applicable fines come with it.

Incorrect Diagnosis and Reporting

Since the medical facilitators are more knowledgeable than ordinary people hence it’s easy to fool them with complicated medical procedures and diagnoses that they may not even have. Fraudulent doctors will diagnose their patients with non-existent illnesses and suggest unnecessary medical treatments to get paid more. For example, this kind of fraud includes over-prescription or not prescribing the right medicines, unnecessary surgeries, and lastly, fake diagnosis of cancer that will lead to either extra or unnecessary chemotherapy.

This is the reason why a second opinion is always the best option if in doubt. Also, if you’re aware that someone is falsifying illnesses and treatments, you can sue them under the False Claim Act.

Illegal Referrals and Kickbacks

Also, under the False Claims Act, it’s illegal that a health care provider participates in kickbacks from referrals. This includes using bribery to achieve exclusive patient referrals as well. Fraudulent health care providers use the bribes to increase profit as they use a kickback scheme to defraud an insurance company. For example, they partner with other health care providers in exchange for patient-related information and exchange of kickbacks.

Conclusion

Corruption and fraud in the health care system are less likely in societies that adhere to the law, provides transparency, and don’t ruin the patient’s trust. However, fraudulent health care providers are creative in defrauding patients and insurance companies by finding a lot of ways to gain more profit. There are a lot of medical scams, but the things mentioned above can get you started in being aware of what’s out there.