Health Care Fraud

Health Care Fraud

The Federal Bureau of Investigation (FBI) estimates that medical fraud costs the country $80 billion a year. From cities to suburbs, white collar thieves will go to any length in order to deceive taxpayers and members of the medical community. At their worst, these scams can devastate consumers.

What is health care fraud?
The definition of health care fraud covers any act aimed at taking advantage of the medical system for illegal gain. For example, if a doctor’s office bills customers for services it did not perform, the provider is committing this crime.

That’s not all, though – there are plenty of other ways individuals and organizations abuse the system, including:

  • Performing procedures that are costly, unnecessary and purposely misdiagnosed
  • Accepting referral payments for recommending patients to a specific practice or clinic
  • Submitting false claims to medical agencies
  • Un-bundling services and up-charging for each individual item
  • Using another person’s medical benefits. This type of fraud can lead to the victim’s benefits being depleted. It could also result in changes to medical records, such as blood type and medications, which could jeopardize the victim’s health.

Protect yourself

Unfortunately, these crimes have become a high-grossing source of income for con artists and unethical members of the medical industry. The National Health Care Anti-Fraud Association reports that $2.27 trillion dollars were spent on health care in 2011 alone. Some of that money has been stolen and siphoned through scammers.

In order to defend yourself against the financial and medical dangers of fraud, you need to know how to sniff it out. While you may not be able to perform a full-scale investigation, you should always ask for detail in every step of your medical treatment.

Start by combing through your Explanation of Benefits, or EOB. document you’ll commonly get from your insurance provider after you receive any sort of medical service.

Your EOB should include a few standard items such as your name, description of service(s) and fees. Keep an eye out for double-billed items, mislabeled procedures or questionable line items. When in doubt, it never hurts to double-check. Many insurers employ a dedicated department to help customers protect themselves against fraud.

Help put an end to health care scams

If something seems fishy, speak up. Whether it’s vishing attacks by telephone, door-to-door schemes or health care fraud, consumers need to take every opportunity to protect themselves. It starts with you; align yourself with companies and physicians you can trust, keep track of your records and make yourself heard. Your attentiveness is your best defense.