The healthcare industry has been plagued with fraud. One particular area is improper billing schemes, perpetrated against Medicare, Medicaid & private insurance carriers. The FBI established a federal task force focused solely on healthcare fraud because the field has been so inundated. As patients, everyone can play their part to prevent & detect healthcare fraud by gaining an understanding of how providers bill for services & what information patients receive.
What are the Common Medical Billing Schemes?
- Improper Billing – The provider bills health insurers twice for the same procedure, for procedures not performed, and/or bills the patient for the contractual difference.
- Upcoding – Charges are billed for higher priced services than actually performed.
- Phantom Treatments – Medical provider bills the health insurer for procedures and/or tests that the patient did not receive, or for medical products not ordered and received. The elderly are often the target for medical billing improprieties.
- Unbundling – The provider bills for a procedure as separate steps versus all-inclusive as required.
- Unnecessary procedures – The provider performs & bills medically unnecessary treatments to generate greater income.
How You Can Do Your Part In Healthcare Fraud
- REVIEW & scrutinize all explanation of benefits (EOB) statements and provider bills carefully. Review those of elderly family and friends for their benefit and protection.
- MAINTAIN detailed records of all medical care, including treatments, dates, & names of the providers.
- PROTECT your insurance card and social security number. Be careful about who you share this information with, and provide it only when absolutely necessary.
- BEWARE of free healthcare services or treatments, or those offered at discounted prices. These are generally schemes to collect your personal data and insurance information so that fraudulent bills can be processed.