4 Types of Fraud Billing of Insurance and Healthcare Programs
1) Billing for Services
Among the most common types of healthcare fraud is billing for services that were never performed. This can be done two ways. One way is that the doctor may take a legitimate patient’s bill and add on extra services in hopes that they will not be noticed.
In more extreme cases, a scammer may find out a patient’s name and insurance information and use that to create a fake bill, complete with services that were never rendered.
2) Billing for Durable Medical Equipment
Similarly, some scammers will bill Medicare for durable medical equipment (DME) that was never received. DME is equipment that is intended to assist patients, such as wheelchairs. Many DME scams involve scooters.
Misrepresentation of services or upcoding is also a common type of fraud. In this type of fraud billing, a provider falsifies the claim in order to receive compensation for more expensive services. In Broward County, a criminal lawyer in Fort Lauderdale can review evidence of a client’s billing practices when building a case against Florida insurance fraud allegations.
In some cases, billing will involve charging separately for services that should be billed together. This is called “unbundling.” Medicare and Medicaid may specify that certain services are commonly performed together, and therefore should be billed at a packaged rate.
This may be the case when sending for blood tests normally performed together. If the services are charged independently, they may render a higher overall rate for the medical office. Or, if a patient undergoes a surgery, the surgery may have just one code for billing. However, some unprofessional doctors may bill each portion of the surgery separately, resulting in a higher overall payout from the insurance company.
Many scams also involve behavioral health services. For example, a provider may have a group therapy session but attempt to maximize his or her claim payments by charging each person in the group for an individual session.
If accused of these or other types of insurance fraud in Florida, medical practitioners in Broward County can contact our Fort Lauderdale healthcare fraud attorney for legal guidance.
Contact Our Fort Lauderdale Healthcare Fraud Attorney Today
Healthcare fraud billing is on the rise, so those who defraud the system – even accidently – are placed under intense scrutiny. The government does not tolerate this type of fraud and therefore will move quickly to file charges and enforce penalties for Florida insurance fraud.
Fraud is a serious crime that can result in severe punishment if convicted. Providers and patients accused of Florida insurance fraud may consult a Fort Lauderdale healthcare fraud attorney at The Law Offices of Robert David Malove. Contact us today at (954) 861-0384 to discuss allegations of fraud billing.