The Different Types of Healthcare Fraud and How to Prevent It
The United States Occupational Healthcare faces multiple charges before a Chicago judge for misrepresentation and fraud. It is accused of bribing doctors and other health care providers to make them prescribe their products to patients, as well as of making false claims to the government health insurance programs Medicare and Medicaid.
The company’s chief executive, Rick Young, and two other executives have been indicted by a federal grand jury on charges of conspiracy, honest services fraud, wire fraud and money laundering. If convicted, they could each face up to 20 years in prison.
This case is just one example of healthcare fraud, which is a serious problem in the United States. According to the National Health Care Anti-Fraud Association, healthcare fraud costs the country billions of dollars every year.
In this essay, we will take a look at what healthcare fraud is, what its different types are, and how it can be prevented.
2. What is healthcare fraud?
Healthcare fraud is any type of deception or misrepresentation that is used to obtain money from a healthcare program. It can be committed by patients, providers, or third-party companies.
Patients can commit healthcare fraud by exaggerating their symptoms or lying about their medical history in order to get treatment that they are not entitled to. Providers can commit healthcare fraud by billing for services that were not actually provided, or by charging more than they should for the services that they did provide. Third-party companies can commit healthcare fraud by billing for services that were never rendered, or by paying kickbacks to providers in exchange for referral business.
According to the Federal Bureau of Investigation (FBI), healthcare fraud is one of the fastest growing crimes in the United States. In 2010, the FBI estimated that healthcare fraud cost the government $80 billion per year. This number has only grown in recent years as the cost of healthcare has increased.
3. Types of healthcare fraud
There are many different types of healthcare fraud. Here are some of the most common:
• Billing for services that were never provided: This is when a provider bills for services that were never actually rendered. This can be done by billing for more visits than were actually made, or by billing for tests or procedures that were never actually performed.
• Upcoding: This is when a provider bills for a more expensive service than was actually provided. For example, a provider may bill for an MRI when only an X-ray was performed.
• Unbundling: This is when a provider bills for each individual service rather than bundling them together. For example, a provider may bill for an office visit, an EKG, and blood work separately rather than billing them all together as one visit.
• Double billing: This is when a provider bills both the patient and the insurance company for the same service.
• Fraudulent prescriptions: This is when a provider writes a prescription for a medication that is not needed, or writes it for more pills than are needed. Prescriptions can also be fraudulent if they are written for non-existent conditions or if they are written without ever seeing the patient.
• Kickbacks: This is when a provider receives payment from a third-party company in exchange for referring patients to them. Kickbacks can be in the form of money, gifts, or free trips.
4. Case study: Occupational Healthcare Corp
The case of Occupational Healthcare Corp is just one example of healthcare fraud. This company is accused of bribing doctors and other health care providers to make them prescribe their products to patients, as well as of making false claims to the government health insurance programs Medicare and Medicaid.
If convicted, the company’s chief executive, Rick Young, and two other executives could each face up to 20 years in prison.
This case highlights the importance of preventing healthcare fraud. The cost of healthcare fraud is not just financial; it also takes a toll on the quality of care that patients receive. When providers are paid kickbacks for prescribing certain medications, they may be more likely to prescribe those medications even when they are not necessary. This can lead to patients taking medications that they don’t need and experiencing side effects that could have been avoided.
Healthcare fraud is a serious problem in the United States. It costs the country billions of dollars every year, and it takes a toll on the quality of care that patients receive. Healthcare fraud can be committed by patients, providers, or third-party companies.
There are many different types of healthcare fraud, but some of the most common include billing for services that were never provided, upcoding, unbundling, double billing, fraudulent prescriptions, and kickbacks.
The best way to prevent healthcare fraud is to be aware of its different forms and to report any suspicious activity.