With a tight economy, budgetary cutbacks, and lawmakers looking for ever increasing ways to recoup money, healthcare fraud and abuse has become an issue of singular focus lately. Let’s discuss the cost of healthcare fraud and abuse.

Back in 2010 CNN ran an excellent article on the cost of fraud and abuse (for article click here).  Little has changed since then and healthcare fraud and abuse is still having a staggering impact on the country’s bottom line.  In the upcoming week we will take a look at some of the key healthcare fraud related issues including;

  • The Qui Tam provisions of the False Claims Act
  • Reverse false claims and Medicare RAC audits
  • The Billion dollar cost of Fraud
  • What fraud initiatives are on the horizon

Examples of Healthcare Fraud & Abuse

A stafck of US currency (a $100 bill is seen) and a set of silver handcuffs. Healthcare fraud and abuse is pervasive in the US healthcare system

Healthcare fraud and abuse is pervasive in the US healthcare system

Healthcare fraud and abuse encompass a range of deceptive practices that exploit the healthcare system for personal gain. These examples illustrate the diverse ways individuals and entities can exploit the healthcare system for illicit financial gains, compromising the integrity of patient care and inflating costs. Here are some specific examples:

  1. Billing Fraud:
    • Upcoding: Inflating charges for services rendered.
    • Phantom Billing: Billing for services or procedures that never took place.
  2. Kickbacks:
    • Receiving payment for patient referrals or recommending unnecessary services.
  3. Unbundling:
    • Breaking down bundled services to charge separately and increase reimbursement.
  4. False Certification:
    • Providing false information to gain approval for healthcare benefits or services.
  5. Identity Theft:
    • Using stolen patient information to obtain medical services or submit fraudulent claims.
  6. Prescription Fraud:
    • Overprescribing medications for personal financial gain.
  7. Medicare/Medicaid Fraud:
    • Submitting false claims to government healthcare programs.
  8. Phantom Patients:
    • Creating fake patients to bill for non-existent services.
  9. Upgraded Services Fraud:
    • Billing for more expensive services than those actually provided.
  10. Provider Credentialing Fraud:
    • Falsifying qualifications to become an approved healthcare provider.

Here is a video from NBC Nightly News…..this story focuses on Florida, a state identified as one of the most egregious offenders when it comes to Medicaid/Medicare fraud.

Visit msnbc.com for breaking news, world news, and news about the economy

Visit our blog to learn more about how organizations can detect and avoid the growing cost of healthcare fraud and abuse.