by | last updated on January 18, 2016
The various types of healthcare fraud are a major concern for the healthcare system in the United States. According to the Federal Bureau of Investigation (FBI), healthcare fraud costs the U.S. $80 billion annually. Fraud affects everyone, as these costs are absorbed by higher health care insurance premiums. Because fraud has become widespread – and can include Medicaid and Medicare fraud – law enforcement is strict about stopping healthcare fraud and punishing offenders harshly.However, sometimes healthcare fraud occurs without the provider or patient even knowing it happened. Sometimes inadvertent billing errors can trigger a fraud alert and cause a provider to be questioned and even wrongfully accused. In addition, patients who are unaware that family members or scam artists are using their ID cards illegally could be subject to a fraud investigation. Robert Malove, a fraud defense lawyer with headquarters in Fort Lauderdale, can review details of a case to help build a defense that addresses accusations of medical fraud.

Common Types of Healthcare Fraud by Providers

Some providers will intentionally lie on their claim forms about the services they rendered. Providers do this in order to receive a greater amount of reimbursement. However, doctors and their staff may sometimes use an incorrect diagnosis or procedure code or make other inadvertent mistakes. Even a simple error can sometimes lead to medical fraud allegations and charges.

Some common types of provider fraud include:

  • billing for services or equipment never provided to the patient;
  • unbundling services (billing for each service individually when they should be billed as an inclusive panel);
  • charging for the same service multiple times;
  • billing for complex services when basic services were rendered; and
  • up-coding (using billing codes worth more than the service that was actually rendered).
  • violations of the anti-kickback statute

The government takes these and other types of healthcare fraud seriously. However, a simple mistake – such as a wrong number in a code or a service accidentally billed twice – can alert the authorities to possible medical fraud. Providers who are accused of fraud can work with their fraud defense lawyer in Fort Lauderdale to gather the necessary records and other evidence that may help prove the provider’s innocence or reduce potential penalties.

Common Types of Healthcare Fraud by Patients

Although providers are often the ones accused of medical fraud, patients may be accused as well. A qualified healthcare fraud defense lawyer can help patients who are accused of unintentional fraud.

Some common types of fraud caused by patients include:

  • using someone else’s member ID card;
  • adding ineligible family members to a policy for coverage;
  • failure to remove a person from the policy who is no longer eligible for coverage; and
  • obtaining prescriptions for painkillers and other common prescription drugs from more than one doctor.

Attorney Robert Malove Can Help if Accused of Medical Fraud

Authorities are focused on detecting medical fraud early, but some may find themselves wrongfully accused or may commit mistakes that draws accusations of fraud. Robert Malove is a fraud defense lawyer in Fort Lauderdale who can help individuals — including patients and providers — understand their legal rights when facing charges or allegations related to one or more of the types of healthcare fraud. Call 954-861-0384.