What Is Health Care Fraud?

Posted on in Fraud

fraudThere are times when we all need to seek assistance for our health issues. Whether we have a virus that will simply not go away, or if we have a serious illness such as cancer, there is such a great feeling that we can trust our health care professionals and providers. For over 10 years, there have been changes to health care. However, during this period of time, there have been many incidents where health care fraud occurs, and it is very important to understand what constitutes as health care fraud.

Methods of Health Care Fraud

Most of the time, health care fraud is committed by a minority of health care providers who are not honest. Unfortunately, health care fraud destroys the reputation of physicians and healthcare insurance companies. The most common ways for health care providers to commit fraud include:

  • Billing for health care services or procedures that were never rendered;
  • Upcoding, or billing for more expensive services or procedures than actually rendered;
  • Performing services deemed unnecessary for the purpose of collecting insurance payments;
  • Misrepresenting treatments that were not covered as medically necessary covered treatments;
  • Falsifying patient information to justify services or procedures that were not medically necessary;
  • Unbundling, or billing each step of a procedure as if it was a separate procedure;
  • Billing a patient more than the co-pay amount for services or procedures prepaid or fully paid by the benefit plan;
  • Accepting kickbacks, or bribes, for referrals; and
  • Waiving co-pays or deductibles for health care and over-billing the insurance carrier or benefit plan.

According to the National Health Care Anti-Fraud Association, or NHCAA, health care fraud will cause a financial loss of over ten billion dollars per year. Depending on the type of health care coverage, health care fraud often comes in the forms of higher premiums, more expenses that come out of pocket, and reduced benefits or coverage. Health insurance could be made unrealistic for those who have been greatly affected by health care fraud.

Call a Cook County White Collar Crime Defense Lawyer

Being charged with health care fraud is a serious crime that can come with undesirable consequences. If you have been accused of providing fraudulent health care information, it is important to seek effective legal representation. At the Law Offices of Hal M. Garfinkel LLC, Chicago Criminal Defense Attorney, we understand your rights, and we will fight to protect those rights. To schedule a free initial consultation with one of our trusted Chicago federal crimes defense attorneys, please call 312-629-0669 to discuss your case.


Back to Top