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Certain billing practices can constitute fraud

On Behalf of | Mar 5, 2021 | White Collar Crimes

Your medical facility probably had to make some changes and complete a lot of paperwork to be able to accept government insurance like Medicare and Medicaid. Signing a government contract to accept these federal insurance programs can substantially increase the pool of patients that might come to your medical practice.

With the unquestionable benefits of accepting government insurance at your facility comes additional risk as well. Some of the billing practices that people employ to maximize their business’s income might violate federal laws and constitute insurance billing fraud.

What are common forms of provider insurance fraud?

You can typically break health insurance fraud in to two main categories. Consumer fraud involves individuals falsifying claims or trying to obtain benefits they shouldn’t receive. Provider fraud involves a medical business improperly charging the government for the services they provide.

One of the most glaring and obvious forms of provider fraud involves billing for appointments that never happen. Some people see this practice as a victimless crime because the patient has no financial responsibility, but the provider can boost their income with just a few mouse clicks.

If your company would never bill for services not rendered, some of your billing practices could border on being illegal. Choosing to tweak the code that you input to bill for a slightly more expensive procedure than the one performed violates the law. Additionally, charging insurance for multiple, individual procedures that usually get bundled together to save the insurance provider money is also a form of fraud, sometimes called unbundling.

Anyone accused of making false claims against government insurance programs could face federal charges. Both the person financially benefiting from such charges and the people knowingly involved in illegal billing, even if they don’t receive money from those charges, could end up facing criminal consequences