Many people join the field of health care to assist others. Unfortunately, no one is perfect, and mistakes can happen.
When a medical practitioner commits an error, the individual may face accusations of fraud. Understanding the most common forms of health care fraud can help a person stay on the lookout for mistakes or prepare to fight an unjust charge.
Permitting staff and nurses to do physician examinations
While understaffed or behind schedule, a doctor or facility might have a nurse or other care staff handle an examination that a doctor should do. If the provider bills Medicare or Medicaid for the rate of a doctor doing the assignment, the government considers this a false claim.
Committing medical equipment fraud
Medical equipment manufacturers might offer products to individuals and say that the items are free. Sometimes the supplies are unnecessary, or the company does not deliver them. In either case, charging insurers for the equipment is a form of fraud.
Upcoding is often the most common form of health care fraud that can happen by mistake. A facility could charge patients for services they did not receive. In some cases, such services are higher than a patient’s actual treatment. Sometimes coders exaggerate a patient’s diagnosis, which increases their reimbursement rate.
Billing for medically unnecessary services
In other cases, some providers perform a procedure that an insurer does not cover. The practitioner might bill an insurer as if the operation was necessary by giving it another name. This is more typical with cosmetic surgery.
Health care fraud does happen intentionally at times, but honest mistakes and well-meaning errors can occur. However, prosecutors do not necessarily focus on the provider’s intentions and can bring charges against a defendant with harsh penalties.