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The basics of healthcare fraud

Healthcare fraud is a term many people may be familiar with but may not know exactly what it refers to. Healthcare fraud refers to deceptive practices employed for profit in the health care industry. Healthcare fraud can be costly in a variety of ways so understanding the legal process surrounding it is helpful.

Healthcare fraud specifically refers to the deliberate deception or misrepresentation of services that results in an unauthorized healthcare reimbursement. The most common categories of healthcare fraud include health insurance and medical billing fraud; Medicare and Medicaid fraud; home health care fraud; and prescription drug fraud and abuse. Healthcare fraud can have criminal consequences and may result in serious penalties for anyone accused of it.

Specific types or examples of healthcare fraud include billing for medical services that were not actually performed; upcoding which is the practice of billing for services that are more expensive than those that were actually performed; unbundling which is billing for each stage of a procedure as a separate procedure; falsifying the diagnosis of a patient to justify procedures that are not medically needed; accepting kickbacks for patient referrals; and waiving patient co-pays and deductibles and overbilling the insurance carrier.

Because of the serious nature of healthcare fraud and healthcare fraud charges, it is important for anyone involved in them to be familiar with what is considered healthcare fraud and what to do when accused of committing healthcare fraud. Healthcare fraud is a serious issue which is why understanding the legal resources related to it is important.

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