Fraud & Abuse in Medical Billing

Medical billing fraud drives high health care costs in the United States.

Medical billing fraud and abuse contribute immensely to the high cost of health care in the United States. It is a criminal activity that often goes undetected for years due to highly automated and complex medical billing processes.

Fraud and Abuse

An insurance company or Medicare is sent an illicit bill for patient care that never happened, such as overcharging for care, billing for care that never occurred or and even by inventing imaginary medical problems for a patient. Often, a person will be tricked into providing his medical assistance identification number; his name might be used for fictitious medical treatment as well.

Prevention

Legislation has been enacted to deter false medical billing. Those held responsible for preventing and reporting fraud include Medicare patients, providers of Medicaid services, such as doctors, and state or federal government agencies, such as the Federal Bureau of Investigation. The best way to prevent fraud is to notify Medicaid beneficiaries of the potential warning signs.

Victims of Fraud

According to Medicare, "Medicare fraud takes a lot of money every year from the Medicare program. People with Medicare and health insurance pay for it with higher premiums." If you feel that you have been a victim of Medicare fraud, then you need to speak with a qualified attorney.

References

• Personal Injury Attorney: Whistleblower Coding and Billing Fraud
• Medicare: Medicare Fraud
• Pennsylvania Dept. of Public Welfare: MA Fraud and Abuse - General Information