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Common forms of healthcare fraud and how to avoid them

On Behalf of | May 23, 2019 | Fraud, White Collar Crimes

People enter the healthcare industry for various reasons. It may be a family tradition to work in the medical field. Some people look forward to the eventual financial wealth they will experience. Others have a giving and helpful personality, and some find research and discovery fascinating.

Regardless of why you may have become a medical professional, you may one day find yourself facing charges of healthcare fraud. It is the most pervasive type of insurance fraud, reveals Healthcare Business and Technology, costing billions of dollars each year.

Examples of healthcare fraud

The best course of action is to avoid these common practices that can get you into legal trouble:

  • Kickbacks: You may think it harmless to set up a reward system with other professionals for patient referrals. However, this is illegal. Even something as seemingly innocent as a gift can be a red flag to authorities.
  • Improper billing: The complicated and confusing nature of medical coding and billing is not secret, but this fact is not a defense against fraud accusations. Unbundling procedures, upcoding and misclassifying treatments are common types of fraud that can land you in hot water.
  • Unnecessary services: Some patients ask for numerous tests and procedures, and even some doctors prefer being thorough to err on the side of caution and prevent misdiagnosis. The catch is to ensure you can prove that all services you provide are necessary and that you are not ordering tests just to bill more from insurance companies.
  • False records: Maintaining accurate medical records is another challenge in healthcare, but outright falsifying them is a clear form of fraud.

Tips for avoiding charges

The last thing you need is criminal charges to harm your reputation and put your license at risk. You can eliminate the chances by staying up-to-date on regulations to ensure compliance, training your staff properly so they do not make errors and keeping good records to show your hands are clean. Sometimes, the charges will still come, in which case you need strong legal representation to avoid or minimize the consequences.


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