Discussion case on healthcare fraud. Healthcare fraud is rampant in our society on a national and a local scale. Please locate one of the following:
Discussion case on healthcare fraud
- a newspaper article discussing a case of healthcare fraud in your local community;
- a news report discussing the impact of healthcare fraud on the cost of healthcare
Overview
Health Care Fraud
Health care fraud is not a victimless crime. It affects everyone—individuals and businesses alike—and causes tens of billions of dollars in losses each year. It can raise health insurance premiums, expose you to unnecessary medical procedures, and increase taxes.
Health care fraud can be committed by medical providers, patients, and others who intentionally deceive the health care system to receive unlawful benefits or payments.
The FBI is the primary agency for investigating health care fraud, for both federal and private insurance programs.
The FBI investigates these crimes in partnership with:
- Federal, state, and local agencies
- Healthcare Fraud Prevention Partnership
- Insurance groups such as the National Health Care Anti-Fraud Association, the National Insurance Crime Bureau, and insurance investigative units
Common Types of Health Care Fraud
Fraud Committed by Medical Providers
- Double billing: Submitting multiple claims for the same service
- Phantom billing: Billing for a service visit or supplies the patient never received
- Unbundling: Submitting multiple bills for the same service
- Upcoding: Billing for a more expensive service than the patient actually received
Fraud Committed by Patients and Other Individuals
- Bogus marketing: Convincing people to provide their health insurance identification number and other personal information to bill for non-rendered services, steal their identity, or enroll them in a fake benefit plan
- Identity theft/identity swapping: Using another person’s health insurance or allowing another person to use your insurance
- Impersonating a health care professional: Providing or billing for health services or equipment without a license
Fraud Involving Prescriptions
- Forgery: Creating or using forged prescriptions
- Diversion: Diverting legal prescriptions for illegal uses, such as selling your prescription medication
- Doctor shopping: Visiting multiple providers to get prescriptions for controlled substances or getting prescriptions from medical offices that engage in unethical practices
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