Fraud is a form of white collar crime that has nearly countless types and methods. In the healthcare industry, however, these allegations can be troublesome as there are stacks of documentation and numerous departments that need to be investigated and thoroughly defended through the legal process.
What are some of the common types of healthcare fraud?
While many people equate healthcare fraud to the simple act of overbilling, there are countless nuances, including:
- Billing for services not rendered. Whether these services were never actually provided or performed, “upcoding” often also includes an inflation of the patient’s underlying diagnosis to make the additional procedures necessary.
- Performing medically unnecessary services. This can include ordering unnecessary diagnostic tests, over-testing or simply ordering extraneous procedures after a diagnosis has become clear.
- Billing for more expensive services. In these situations, a medical professional might bill for a higher-order procedure than the one that was actually completed.
- Unbundling. It is not uncommon for a client to be billed for each separate step of a procedure as if it were a separate procedure.
- Falsifying a patient’s diagnosis. This can be done to justify additional tests, surgeries or other procedures that wouldn’t otherwise be necessary.
Even an accusation of fraud can destroy a career. Facing loss of professional licensure and other criminal penalties, it is wise to discuss your situation with a skilled healthcare fraud defense attorney.