Health care fraud is big business. As a result, it is attracting a lot of attention from federal authorities.
If anybody needed a sharp reminder of just how aggressive the federal government has become toward health care fraud, they only need look at the recent arrests of almost 200 people – many of them doctors, nurse practitioners and others with professional degrees – in a nationwide “crackdown” on what is alleged to involve nearly $2.7 billion in false Medicare claims.
While that figure may seem pretty dramatic, the reality is that the government believes that more than $100 billion in tax dollars gets wasted every year in health care waste and fraud schemes, so $2.7 billion is a mere “drop in the bucket.”
What sorts of actions are attracting the attention of authorities?
Health care fraud comes in all kinds of forms, most of them involving deliberate deceptions or misrepresentation for financial gain. Some of the possibilities include:
- Billing for services that were not actually rendered
- Upcoding, or billing for procedures that are more expensive than what was actually provided
- Unbundling, or separating a procedure into parts and billing individually to receive higher reimbursement amounts
- Duplicate billing, or submitting multiple claims for the same service
- Prescription fraud, or writing unnecessary prescriptions
- Falsifying diagnosis for patients to justify unnecessary tests, surgeries or treatments
Unfortunately, it’s far too easy for innocent parties – such as receptionists, billing clerks and nurses – to get caught up in these grand sweeps once the scams fall apart and arrests start being made. If you have been caught up in a bust against the medical provider you work for, do not try to explain yourself or talk your way out of the situation. Federal laws are complex, and you could accidentally incriminate yourself in your attempt to clear your name. It’s far safer to seek experienced legal guidance as you navigate the situation.