Understanding Healthcare Fraud: An Overview

Healthcare fraud is the intentional deception or misrepresentation of information for financial gain within the healthcare industry. This type of fraud can occur in various forms and involves individuals or organizations knowingly providing false information or engaging in deceptive practices to obtain unauthorized benefits or payments.

Types of healthcare fraud:

• Billing Fraud: Submitting false claims to insurance companies or government healthcare programs for services or procedures that were not provided, unnecessary, or improperly documented.
• Kickbacks: Receiving or providing financial incentives or kickbacks in exchange for patient referrals, services, or the purchase of medical equipment or supplies.
• Upcoding and Unbundling:  Manipulating billing codes to overstate the severity of a patient's condition or breaking down a procedure into separate billable components to maximize reimbursement. 
• Phantom Billing:  Billing for services or treatments that were never rendered, including fictitious patients or procedures.
• Identity Theft:  Using someone else's identity to obtain medical services or prescription medications.
• Medicare and Medicaid Fraud:  Exploiting government healthcare programs by submitting false claims or engaging in practices that violate program rules.