There are times when health care fraud is an orchestrated scheme by an individual or company with the idea of making a financial gain. There are also situations in which a person or company makes an honest mistake, however, it is seen by outsiders as some type of fraud.
To better understand health care fraud, it is a good idea to take a look at some of the most common examples. These include:
— Billing for services that were never provided to a patient.
— Billing for more expensive services than provided. This is known in the medical world as upcoding.
— Performing services that are unnecessary as a means of generating insurance payments.
— Billing a patient in excess of the copayment amount.
— Accepting any type of kickback in exchange for patient referrals.
These are just some of the many types of health care fraud. On the surface, it appears relatively clear that these types of behavior are against the law. Even so, there is gray area due to the many types of fraud and the intended behavior.
If a person or company is charged with health care fraud, they need to learn more about what they are being accused of. Along with this, it is important to understand how the case will move through the legal system.
Health care fraud is a serious crime, as it can lead to punishments such as prison time for the mastermind, along with large fines. This is why it is a must to understand the charge and how to defend against it.
Source: The National Health Care Anti-Fraud Association, “What Does Health Care Fraud Look Like?,” accessed Nov. 05, 2015