Notes

Healthcare Scams & How to Report Healthcare Fraud
Healthcare is one of the biggest targets of fraud. Given the sheer number of people that rely on this industry for medicine, therapy, technology, and the like, this statement should come as little surprise. While most companies operate under lawful practices, ensuring that clients receive the best care possible, others aren’t as law-abiding. In fact, it’s the latter group that has brought rise to healthcare fraud, which costs companies and individuals alike at the benefit of larger establishments. With this in here, here are some common healthcare scams and information on how to report healthcare fraud .

Misrepresentation – When discussing healthcare scams, misrepresentation is a good place to begin. Simply put, this is when reports are given using information that is simply untrue. This can be done as a way to help companies sell more expensive products or make more money at the expense of patients. Keep in mind that information can be misrepresented in a number of ways. The date that a service was rendered, where the service was provided, and the company associated with it can be misrepresented, resulting in inaccurate information. This is just one of the reasons why individuals may step forward to report healthcare company fraud .

Medical Identity Theft – For those that are unaware, medical identity theft refers to a situation where one’s medical identity, such as healthcare coverage, is used by another party so that they can gain access to healthcare goods and services. With this information, an individual can fill a prescription or secure a device they don’t need for a medical condition they don’t have. Medical identity theft can result in a fraudster benefiting at the expense of an innocent party with a healthcare policy. For the average person, keeping your healthcare information private is important for reasons such as this.

Billing for Services Not Rendered – What would happen if an individual was billed for a service that was never performed or provided? This is a relatively common form of healthcare fraud and it’s a serious one to boot. Essentially, a medical provider may submit a claim form to a government healthcare plan, detailing a service that was allegedly performed. If whistleblower programs is looking to report healthcare industry fraud based on a service that was never brought to fruition, they will need to provide solid documentation to do so. Otherwise, it will be difficult, if not impossible, for an attorney to move forward with the case.

Upcoding reporting healthcare fraud as the billing of services at a level of complexity higher than documented, upcoding is a form of healthcare fraud that to be mindful of. In other words, upcoding is used to sell or market products of a higher quality than needed, especially if those higher-quality products are considerably more expensive. For example, a patient may schedule a doctor’s appointment for a yearly checkup, which would be simple compared to a more complex evaluation. If the medical facility bills the patient for the latter, this is upcoding at work.

Kickbacks – This is yet another healthcare scam that should be cause for concern, especially among those that work healthcare providers to receive products and services. A kickback refers to a situation where an individual provides money or goods to a healthcare provider, the goal being to ensure that a physician working for said provider makes recommendations to patients that benefit the aforementioned individual. Essentially, the paying party’s products and services would be prioritized, even if they are at a lower level of quality compared to the competition. This can possibly result in patients receiving lower-quality assistance over time.

Overuse of Services – While billing for not services not rendered is a crime, as mentioned earlier, the same can be said when the same or similar services are used to excess. This is done when a medical provider bills an individual for a service that’s either not needed or not needed at the dose or degree they say. In fact, when this form of fraud takes place, it’s not unfathomable for an unsuspecting individual to continually be billed as long as they have healthcare coverage or the means to make payments. This is yet another reason why one may report healthcare fraud, provided they have the information to back up their claims.

Now that you have a better understanding of what healthcare scams entail, it’s important to know how to blow the whistle. This is where whistleblower experts come into the picture, assisting potential whistleblowers in their quest to shed light on fraudulent practices. Attorneys can help whistleblowers organize their data and, more importantly, take them through the necessary steps to ensure that cases are filed. Fraudulent cases vary based on potential rewards, but if a whistleblower provides substantial evidence that proves their case right, they stand to make a profit. All the while, they can rest easy knowing that their livelihood will be protected, meaning that possible blowback from their workplace won’t follow.
Website: https://whistleblowerlawfirms.com/types-of-fraud/report-healthcare-fraud/