How to Know Healthcare Fraud is Taking Place

Healthcare fraud is a deliberate, dishonest act involving misrepresentation and misstatement of facts and treatment relating to healthcare services. In recent years, fraudulent behavior has become sophisticated, which means it may be harder to spot than ever before. If you suspect healthcare fraud relating to your medical records or at the facility you receive medical services, the following things may prove that to be true.

Care Hasn’t Been Provided

Sometimes, you may not realize the importance of healthcare records security until you find yourself embroiled in a case of healthcare fraud. One of the most common types relates to care and services documented but not actually provided.

Unfortunately, this case of fraud is easy for medical care providers and facilities to perform. They can submit forms to insurance companies or government healthcare plans, add medical codes on specific dates to signal treatment, and receive monetary compensation. You may not have received the treatment, but your medical team was paid to give it.

Prescription Drug Theft

Prescription drug theft is a common problem, but what you may not know is that it also happens among pharmacists. In the decade from 2003 to 2013, 41 pharmacy technicians were caught stealing drugs from pharmacy shelves and even patients. They lost their licenses as a result. Keeping medical data safe may not stop employee theft, but understanding what irregularities in claims and prescriptions look like may significantly reduce the risk.

Non-Covered Services Receiving Coverage

Many Americans understand the importance of healthcare insurance, which covers you for many procedures and treatment types that may otherwise cost thousands of dollars. If experimental treatment types are tried that are not covered by insurance, some medical providers will call them something else to make a claim. Fortunately, investigation teams can use a variety of medical canvassing solutions to uncover such fraudulent activities.

Charging for Unnecessary Services

Vulnerable members of society, such as older adults, may be more at risk of healthcare fraud than others. For example, if they are taken into care after a fall, a number of unnecessary procedures and tests may be performed for the simple sake of revenue gathering. The more services that are provided, the more money a medical facility may receive. It can take complex investigations to shed light on such sophisticated fraud efforts.

Altering Dates

Healthcare is expensive in the United States, with the average price of a doctor’s appointment in the hundreds of dollars. Some medical practitioners may alter the dates of medical services being provided to increase their revenue from insurance companies.

If services are provided on two different occasions, they are able to claim for two visits. This fraud can be uncovered by comparing service dates to appointment dates, but it’s unknown just how many of these fraudulent claims are not picked up.   

Healthcare fraud costs the United States billions of dollars annually. While some fraud schemes can be sophisticated, knowledge is power. By being aware of common fraud types and consulting the experts, there may be a way to reduce the number of people who get away with it without any consequences.