Seitles and Litwin | What is Health Care Fraud?

Health Care Fraud is a Huge Issue In the U.S

In simplistic terms, health care fraud is a federal crime that is intentionally committed by a provider or consumer for an unauthorized benefit regarding the amount of health care benefits payable. In other words, it is a scheme that results in extra money for the party that is committing the fraud. Health Care fraud is a huge issue in the United States. According to the National Health Care Anti-Fraud Association, “The United States spends over $2.27 trillion on health care every year. Of that amount, NHCAA estimates that tens of billions of dollars are lost to health care fraud.” There are many forms of this crime. We have listed some examples below.

Provider Health Care Fraud:

• Unbundling – billing each section of a procedure separately as if each was a separate procedure.
• Upcoding – billing for a pricier procedure/service than what was actually performed.
• Billing for services not actually performed.
• Falsifying patient’s diagnosis to get payment for procedures that aren’t medically necessary.
• Over-billing the insurance carrier by waiving patient co-pays or deductibles.
• Billing the patient an additional amount for a copay that was already paid by insurance.
• Accepting kickbacks for patient referrals.

Consumer Health Care Fraud:

• Using someone else’s insurance card/ coverage.
• Altering bills/receipts.
• Filing claims for services/medications that weren’t actually received.

There are some ways that patients can protect themselves and their information from health care fraud.

• Safeguard your insurance information and watch who you share it with.
• Watch for variation in charges for a consistent procedure.
• Be sure that any medical equipment you receive are actually what you ordered.
• Be vigilant of gifts or inducements from visiting providers.

If you or someone you know has been accused of a healthcare fraud crime, call us today at Seitles and Litwin for a no-cost Case Evaluation. We are the Miami Florida Criminal Defense Lawyer experts with “Experience You Can Trust!” Call Now (305) 403-8070