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
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:
Upcoding: Inflating charges for services rendered.
Phantom Billing: Billing for services or procedures that never took place.
Receiving payment for patient referrals or recommending unnecessary services.
Breaking down bundled services to charge separately and increase reimbursement.
Providing false information to gain approval for healthcare benefits or services.
Using stolen patient information to obtain medical services or submit fraudulent claims.
Overprescribing medications for personal financial gain.
Submitting false claims to government healthcare programs.
Creating fake patients to bill for non-existent services.
Upgraded Services Fraud:
Billing for more expensive services than those actually provided.
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.