What Is Health Care Fraud

Full Video Transcript

Health-care fraud occurs when health-care professionals make false or misleading statements in order to benefit financially. Health-care schemes are diverse and often complex. Examples include: Billing for services not rendered Billing for services not medically necessary Double billing for services Upcoding (billing for a more expensive item than the one provided) Unbundling (billing separately for groups of laboratory tests performed together in order to get a higher reimbursement) Fraudulent cost reporting by institutional providers Or receiving kickbacks for patient referrals Part of the reason health-care fraud is so prevalent is because health care is so expensive and is such a massive system. It is not unusual for a carrier to cut a check for over $100,000 to someone it does not even know! But the Justice Department has made health-care fraud a top priority since health-care fraud ends up costing taxpayers by draining billions of dollars from the health-care industry, particularly from Medicaid and Medicare. If you are involved in a health-care practice you believe may be considered fraudulent, contact an attorney for more information.

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