Health care fraud is a criminal act whereby a person or entity makes false or exaggerated claims to a health care provider or insurer, typically for financial gain. It can include billing for services not provided, upcoming or unbundling services, or misrepresenting the condition or treatment of a patient. Health care fraud is a serious problem in the United States, costing billions of dollars each year. There are several types of health care fraud, including: • False billing: This involves submitting claims for services or medical devices that were never provided, or overfilling for services. Upcomingng: This is when a provider bills for a more expensive service than the one that was actually provided. • Unbundling: This is when a provider bills for multiple services that are usually billed as a single service. • Kickbacks: This is when a provider receives a payment in exchange for referring patients or ordering certain services. • Identity theft: This is when someone uses another person's identity to submit fraudulent claims. • Drug diversion: This is when a provider acquires medications and then diverts them for personal use or resale.
HEALTH CARE FRAUD
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FAQ
White collar crimes are characterized by ?deceit, concealment, or violation of trust and are not dependent upon the application or threat of physical force or violence.
A common type of Medicaid or health care fraud scheme is billing for a treatment or procedure never rendered -- such as X-rays, laboratory tests, or drugs that were never dispensed. Fraudulent providers also "upcode" various medical procedures.
Common Types of Health Care Fraud Double billing: Submitting multiple claims for the same service. Phantom billing: Billing for a service visit or supplies the patient never received. Unbundling: Submitting multiple bills for the same service.
Health care fraud is a type of white-collar crime that involves the filing of dishonest health care claims in order to turn a profit. Fraudulent health care schemes come in many forms.
Over a period of at least six years, Fata submitted $34 million USD in fraudulent charges to private health practices and Medicare. At the time of his arrest, Fata owned Michigan Hematology-Oncology, one of Michigan's largest cancer practices.
In California, healthcare fraud is considered a ?wobbler? crime, which means it can be charged as a misdemeanor or a felony. Typically, the prosecutor decides based on the amount of money involved.
False Claims Act 31 U.S.C. It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent. Filing false claims may result in fines of up to three times the programs' loss plus $11,000 per claim filed.