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4 factors leading to federal health care fraud charges

On Behalf of | Jul 28, 2023 | White Collar Crimes |

In the United States, health care fraud is a serious offense. Federal agencies, such as the Federal Bureau of Investigation, are vigilant in rooting out such actions, as they can lead to massive losses for health care providers and taxpayers.

Learn about some of the main reasons why the police might charge someone with federal health care fraud. Knowing these can help you ensure that you, or your health care organization, stay on the right side of the law.

1. Billing for services not rendered

This type of federal health care fraud involves charging for medical services that you never actually provided. It is an intentional act of deception where you might claim to have seen more patients in a day than you really did, or billed someone for a surgical procedure that never happened. It is not just dishonest, it is also illegal.

2. Upcoding charges

Upcoding involves billing a patient or an insurance company using a code that corresponds to a more expensive service than what you provided. It s a deliberate inflation of a patient’s diagnosis to a more severe condition that requires more costly treatment. An example might be if you provided a basic health consultation but billed it as an in-depth examination.

3. Unbundling charges

Unbundling, as it pertains to health care fraud, is when a provider bills each step of a procedure individually, rather than using the code for the entire procedure. This typically leads to higher costs. An example would be billing a surgical procedure in separate parts, like anesthesia, incision and stitching, instead of under a single surgical code.

4. Duplicate charges

Duplicate charging is when you bill twice or more for the same medical service. While this can sometimes happen due to clerical errors, if it is done intentionally to profit from the double payment, it is fraud.

Providing ongoing education and training to your staff about proper billing practices can help prevent fraudulent activity. Remember, the best defense against health care fraud charges is to operate within the legal and ethical guidelines of the health care industry.