Every year, there are millions of health insurance claims submitted in Florida to healthcare companies that try to make quality care a bit more affordable. Out of these millions of claims, a minor percentage of them tend to be fraudulent. If you have been charged with healthcare fraud in West Palm Beach, our white collar crimes lawyers have successfully handled cases like these in the past and are here to help you.
Out of the different kinds of insurance frauds practiced in America, and in particular West Palm Beach, FL, medical insurance fraud accounts for a major portion of the false claims made, showcasing why this issue has become such a major problem.
Kinds of healthcare fraud
It is unfortunate that a large share of medical management sharp practice is undertaken by dishonest healthcare providers who do not truly have the best interest of their patients at heart. Medical management sharp practice can occur in a variety of circumstances, from duplicate tests and procedures, hacking of patient’s medical files, to submitting false claims.
What Is Healthcare Fraud?
The National Health Care Anti-Fraud Association or NHCAA states that the most common kinds of medical management sharp practice are:
• Conducting medically unnecessary treatments for the sole purpose of generating insurance payments.
• Taking kickbacks for patient referrals.
• Falsifying a patient’s diagnosis in order to justify surgeries, tests or other treatments that are not medically necessary.
• Billing for treatments, procedures or services that were never actually rendered through the use of genuine patient information, which is in most cases obtained through identity theft, to falsify entire claims, or by stuffing claims with charges for treatments that never took place.
• Billing for more expensive procedures or services than were actually performed. This is more commonly known as upcoding. It involves falsely billing for a higher priced treatment than was actually rendered. In most cases, it requires inflating a patient’s diagnosis code to a more severe condition that will appear to be more consistent with the false procedure code.
• Billing each phase of treatment as if it were a totally separate procedure. This is normally referred to as unbundling. For instance, a nose job may be billed to a patient’s insurance company as a deviated septum repair.
• Waiving deductibles or co-pays and overbilling the insurance carrier or maybe the benefit plan.
• Billing a patient way above the co-pay amount stipulated for services rendered that were pre-paid or fully paid for by the benefit plan as per the terms of the managed care contract.
The law enforcement agency tasked with the primary role of investing medical management sharp practice is the Federal Bureau of Investigation, better known as the FBI. They have jurisdiction over both private and federal insurance programs. They put a lot of effort in combating such crimes and to reduce the threat posed on the healthcare system in general.
HIPPA or Health Insurance Portability and Accountability Act together with the Health Care Fraud and Abuse Control Program try to regulate the laws and punishments when it comes to healthcare fraud. It is a criminal offense and if found guilty, an individual can spend up 10 years in federal for the crime, in addition to monetary fines.