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Savvy Tips & Helpful Hints

What is Health Care Fraud?

Health care fraud occurs when a company or an individual defrauds an insurer or government health care program, it refers to when unlawful practices are used within the health industry to gain undeserved profit. Fraud has always been an issue worldwide, with statistics showing that financial fraud happens every 15 seconds. Something about fraud occurring within the health care system has always felt like such a personal attack due to the fact it can come from those we think we should be relying on the most. 

Types of health care fraud

Visiting Healthcare Fraud Group Blog: What is a Healthcare Fraud Group defense lawyer in Santa Ana, CA? let’s you see how important of an issue healthcare fraud is. There are a variety of types of health care fraud, including:

When someone goes through a typically large procedure, there are often lots of moving parts involved. Fraudsters can make money from this by billing you for each stage as though they were all separate procedures even though they were not. 

Billing for services not performed, which is when customers have been tricked into believing they owe money for something they didn’t even have done, particularly done towards the elderly as they may be most vulnerable to such schemes

One of the worse kinds of medical fraud is falsifying a patient’s diagnosis to justify procedures that are not medically necessary. This causes strain on a person due to the cost and can severely affect their mental state as they experience the stress of thinking they have problems that are not there. 

Another example is when fraud takes place in the form of billing customers for a more expensive service than the one performed, making people believe they have underpaid and need to give more money and give them false information on what procedures they have had. 

Fraud affects the people who personally experience it and government bodies who have to deal with the fallout.

Health care fraud is a white-collar crime. It is a dishonest scheme that affects everyone involved. These schemes can come in different varieties some include billing by practitioners for care that they never gave, individuals obtaining subsidized prescription pills that they do not need and then selling them on possibly via the black market or just through social circles, changing the dates or descriptions of services as well as changing identities of providers, changing medical records, intentionally giving wrong diagnoses of issues someone is suffering from to maximize payment. 

With the continuing issue of such crimes, it is hard to see a way to combat all types of fraud truly, and new Statistics now show us that for every dollar that is spent on health care, 10 cents of that are going towards paying for fraudulent health care claims.

Once a successful prosecution has finally been made, these can have serious consequences. The health care provider can face prison time, fines, and losing their right to practice in the medical industry ever again. 

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