Undoubtedly, healthcare frauds have been on a roll since the advent of this new age. The healthcare sector has prospered for ages. However, things aren’t going in their favor lately. Due to the constant rising of fraudsters in this noble profession, the once well-earned reputation has been severely tarnished.
Healthcare fraud and abuse have been a part of a common regime throughout the world. Yet, the people have put their fingers crossed and put their trust in the government of their countries. When talking about the healthcare sector, the US has emerged to be the biggest player due to its widespread healthcare sector. Unfortunately, someone truly said that all good things come with a price. Due to the vastness of this sector, certain people took advantage of it to benefit themselves. Although, in the past, the fraud and abuse were done a much smaller scale. But today we have a different picture.
Understanding healthcare fraud
Healthcare fraud is a fraud like any other fraud in any kind of industry. The crooks committing the fraud can be physicians, doctors, dentists, pharmacists, patients, employers, and vendors. The fraudulent activities are carried by an organized group of people to get unjust profit. In doing so, they unintentionally defame healthcare. Defaming the sector is never their primary goal. Yet, these certain black sheep have managed to topple the status of this sector.
At the end of the day, everyone shares the burden of healthcare fraud. Surprisingly, the most attractive thing about the healthcare realm is its huge cash earning. Consequently, intimidating people to commit different kinds of healthcare fraud. In short, healthcare fraud demands a set of false information that is misrepresented as true information. As a result, the government loses approximately 3 to 4 billion dollars per anum.
Inevitably, the financial loss is a major concern that is severely looting the government of their money. In spite of that, there’s a human face to it also. At the end of the day, innocent lives have been put in grave danger. Due to a small number of dishonest people, the reputation of the most trustworthy and honest people has become sully.
Some of the laws devised by the government in this regard are
- Federal conspiracy 18 U.S.C. 1349 law
- Stark Law
- Anti-Kickback statute
- false Claim Act
How do these medical frauds look like
Unlike, the other kinds of fraud committed in other industries, the realm of healthcare is a bit different. Well, it’s a long debate that how they differ, but to get things straight, the healthcare sector holds possibly the most riches.
Honestly, there are dozens of kinds of fraud committed by these fraudsters. However, we are enlisting some of the most common ones.
- Billing for services never rendered
- Acceptance of illegal kickbacks
- Overutilization of services
- False or unnecessary billing for services and insurance programs
- Misrepresentation of the location of services provided
- Billing for expensive services, however, provided but were never needed
- By billing each step of the process separately to increase the amount (unbundling)
- Falsifying the patient’s history of health to conduct the tests that weren’t required
Understanding Healthcare billing frauds
Healthcare frauds tend to be dangerous for both patients and healthcare providers in many ways. One of the most common frauds is being conducted in Medicare and Medicaid programs that result in draining off the government of their rightful taxes.
Some of the most common healthcare frauds are upcoding and unbundling. These are fraudulent medical billing that is the most intoxicating for healthcare service providers and patients.
Upcoding a costly fraudulent medical billing
Upcoding can be defined as an act in which the billing of the services and instruments are inflated. In short, the services rendered are comparatively expensive to what it should have been. The upcoded bill is sent to the payer, or a private health insurer, Medicare, Medicaid, or the patient.
The consequences to these upcoded bills are really severe that inflate the price of healthcare service for everyone. But it is a means of earning a hefty amount of money but by defrauding the government. Therefore, upcoding has been rendered illegal by the government, yet many healthcare providers are accused of doing it. In many cases, the allegations were rectified and the fraudsters were awarded penalities and severe punishments.
Still, some medical care service providers opt for these options to reap illegal benefits and defraud the government. At the end of the day, certain law firms have stood up to the cause and are striving vigorously and untiringly to serve you. The medical billing attorneys are the go-to people if you’ve been fraud by these criminals. The team of medical billing attorneys is well experienced to handle these cases legally and provide every kind of legal assistance to you.
Unbundling another fraudulent billing technique to defraud the government and the patients
Unbundling is also a popular way of defrauding the government. In this case, falsely billing is generated for every step individually to inflate the costs. These services tend to cost you less if bundled cumulatively but they cleverly manipulate the claims. Consequently, causing to generate an inflated bill that is submitted to Medicare. Moreover, the frauding parties receive higher pay that wasn’t justly deserved.
Again Medical billing attorney is the option if you’re a whistleblower. Don’t be discouraged by the odds that are obviously against you. But if you’re choosing the right firm, you shouldn’t be worried.
Other different types of medical billing frauds these lawyers deal are
- Duplicate billing
- Billing for services never rendered
- Providing unnecessary services and then billing for them
- Accepting referral fees from other healthcare services providers
A word of advice to opt for a medical billing attorney
Medical billing is undoubtedly a really complex process. Therefore, if you are going for medical billing, you’ll definitely need a good team of medical billing attorneys who is well versed and educated about all essential procedures step-wise.
The healthcare providers are the first ones to provide claims to these insurance companies for reimbursement. Complete documentation is done with a complete record of services provided in codes. If the claim is proved to be clean then the reimbursement is done to healthcare providers. If reversing the case, the reimbursement is denied to them. At that point, they can appeal and medical billing attorney comes into action.
However, most of the times the records used in documentation are manipulated and altered to get the reimbursement for services never rendered or for services that are expensive and many other such cases, we’ve discussed above. The process involves extensive internal auditing, making this process really complex to be comprehended by a layman.
The internal auditing is the primary cause of fraudulent activities carried out by the service providers. As they can easily manipulate the records to their interest. Here comes the medical billing attorney who can guide you through this lengthy process and urge over the importance of the internal investigation. They tend to be the legal advisors of your company so as to minimize fraudulent activities.
However, the medical billing attorney is also responsible for handling the layman cases, if they’ve been abuse. One can always contact a team of medical billing attorney to help you through this process. In short, these attorneys help the clients to receive justice. Whether it be individuals or healthcare service providers. If you are treated unjustly these attorneys can serve you justice.