10 Health Care Fraud You Should Watch Out For

No matter how honorable the profession is, you'll find that some people are always looking for ways to scam more money into their bank accounts. Even something as honorable as the healthcare industry suffers from corruption due to fraud. In fact, it's estimated that there are tens of billions of dollars being lost to fraud every year. While it may seem to some people that this is a governmental issue, health care fraud affects all of us. Fraud causes inflation, which, in turn, will translate into higher premiums and more expensive health insurance for everyone.

Here are 10 health care frauds that you should always be on the lookout for:

1. Selling You a Service That Can't Be Sold

Many swindlers exploit the lack of information on patients. They offer services that are no longer available to be sold or ones that can't be sold in their state specifically. To give you an example, Medicare supplement plans are pretty popular with seniors enrolled in Medicare. Every senior knows that Plan F is the best, but Medicare experts on Medic Wire explain on their post at https://medicarewire.com/medigap/medicare-supplement-plans/medicare-plan-f-vs-g/ that Plan F is no longer available for anyone who's turning 65 after 2020. The plan is still available to no one else but the older seniors who were already enrolled in the plan. As of 2020, Plan G has become the best plan. 

2. Unbundling of Services

Some providers seek to make extra money from unbundling their services. Instead of billing you for one service for its worth, they break it down to a number of procedures and services. This translates into a higher bill for you. 

3. Billing for Services That Weren't Received

On the other hand, you might even be billed for a service that you haven't received in the first place. This can be done by misusing your personal identification into creating whole new claims of cases that never existed under your name, which is considered identity theft. They can also add more services and procedures on one of your active claims, without you having received them. 

4. Misrepresenting Non-Covered Treatments as Covered

Some may prescribe you some sort of treatment and then issue it under a different name. That usually happens when physicians give their patients' treatment that's not covered in their insurance, but they change it in the records to one that is included in the insurance. 

5. Logging in Different Dates Or Locations of Services Provided

Every visit counts, literally. Whether you pay it out-of-pocket or your insurance covers it, you get charged for an appointment every time you visit your doctor. The easiest way to alter the records would be to document more visits to your doctor, even if you didn't even go. Visits to different places outside of the clinic can also be recorded as clinic-visits. 

6. Logging in Services Under A Different Provider

The services you get should be by a certified health practitioner, and this is what your insurance covers and you pay for. So what happens if another less-qualified member provides you with these services? The quality of your health care becomes compromised, but this is a common occurrence, unfortunately. 

7. Waiving Copayments

Some physicians waive their patient copayments and deductibles, which may seem to be a kind gesture at first. However, doing this on a regular basis is illegal and considered fraudulent, as this will affect the insurance policies for all subscribers and tax-holders as well. 

8. Upcoding

Upcoding means billing extra charges for the services received. So these are services that you have indeed received, but they bill you for more expensive alternatives that you didn't get or didn't need. 

9. False Diagnosis and Over-Utilization of Services 

Physicians do make mistakes, but some of them do them on purpose. It's very easy to trust the physician's medical opinion; after all, they're the experts. But some of them utilize this trust into demanding more tests and procedures, all of which can be justified by their wrong diagnosis. This results in an over-utilization of services that you didn't even need in the first place.

10. Wrong or Unnecessary Drug Prescription

A false diagnosis will put you through countless and unnecessary procedures, and it usually requires getting a drug prescription that you don't even need, either. This will give them extra points with their medication supplier. 

Health fraud is becoming quite scary. It affects everyone in the business, as well as every single one of us. There are many practices taken in the health care system to achieve this fraud, some of which are less obvious than others. However, the result remains the same: it's a serious threat to everyone.