Medical fraud has been a political hot-button for a long time, and the rising cost of medical services in this country virtually guarantees that trend will continue. The vast majority of medical insurance fraud isn’t the result of people getting benefits they don’t deserve but rather medical providers billing for services inappropriately. As a medical professional or billing specialist, the things you do wrong on the job might actually constitute a white-collar crime.
What does provider medical fraud look like?
In a capitalist system, most people agree that any legal means of making more money is generally smart. Still, there are rules and laws that limit how a business or individual can maximize their income. When it comes to billing insurance companies, especially federal insurance plans, what seems like a trick to earn a little more money might actually be a crime.
For example, you could get charged with insurance fraud if you “upcode” a procedure on the billing paperwork to ask for reimbursement for services more expensive than the ones the patient was actually provided. “Unbundling,” which involves intentionally billing separately for services usually billed together at a discounted rate, can also result in insurance fraud allegations. Some medical professionals will even bill for services they never provided and appointments patients never had, while others might go so far as to perform completely unnecessary procedures on their patients so that they can make more money.
Complaints against you can come from patients, co-workers and others — and it doesn’t take much to spark a serious investigation. If you believe that you’re suspected of medical billing fraud, it’s time to start thinking about your defense.