The health care system in the United States relies on a combination of several different kinds of funding. Some people pay for their medical care with private health insurance coverage or specialty coverage, like car insurance or workers’ compensation. Others use government insurance programs.
There are even some people who pay out of pocket for their care. Certain medical practices offering elective procedures may even offer in-house financing or partner with a financing company to help potential patients pay for services.
Health care is big business, and with all of that money comes the risk for fraud. Health care fraud occurs in numerous ways, any of which could potentially lead to criminal charges. You can break the different kinds of health care fraud into three primary categories, all three of which could result in prosecution.
Sometimes, people try to receive health services that they should not. A patient might engage in identity fraud to use someone else’s insurance policy for treatment. They might lie so that they can obtain benefits from a private or state insurance program.
Prescription drug fraud
One of the most common forms of patient-based health care fraud has its own category because it has become such a serious public health concern in recent years. Prescription-seeking fraudulent behavior is part of how the unregulated market maintains a supply of controlled substances.
Doctor shopping, which involves going to see multiple different physicians for the same treatment and medication is a common form of fraud. Falsifying prescription paperwork is another. Some people even steal prescription pads from the doctors that they visit.
Health care provider fraud
While patient fraud can cause problems on a small scale, provider fraud can lead to tens of thousands of dollars in losses.
Providers might perform unnecessary procedures on their patients so that they can bill for those services. They might also try to build her appointments and procedures that never occurred. In some scenarios, they will upgrade the charges submitted to an insurance company to seek more than they deserve given what occurred during an appointment.
Learning about the different kinds of health care fraud and the federal charges that could result can help patients and providers avoid potentially criminal mistakes.