It Pays To Have Experience On Your Side.
free consultation917-639-5370

5 common types of health care fraud

Health care fraud is a prevalent issue in the United States. With people spending $2.27 trillion on health care in 2011, it only makes sense that some providers are fraudulent. Any individual or institution in the health care industry may commit fraud, including hospitals, individual providers, medical equipment suppliers, clinical laboratories and home health agencies.

But what exactly does health care fraud look like? Here are some common examples of fraudulent acts committed by health care providers.

1. Upcoding

When a provider bills a patient for a more expensive service than what was actually provided, it is upcoding. This is especially common for claims involving Medicare and Medicaid. An example of this is submitting a claim for treating a broken arm when the patient only has a sprain.

2. Phantom billing

Some health care providers bill for services they did not provide. The provider usually bills for non-existent services by charging for procedures that did not occur or completely fabricating claims using actual information from patients.

3. False diagnoses

Not all diagnoses are accurate or real. Sometimes, a doctor may falsify a diagnosis in order to conduct procedures that are not necessary. This usually leads to a long list of medically unnecessary services.

4. Illegal referrals

Certain providers bribe other providers to get patient referrals. This is a kickback, which is illegal according to the False Claims Act. Providers may use kickbacks to increase their profits.

5. Waiving deductibles or co-pays

If a provider does not make a patient provide a co-pay, it may be because he or she is defrauding the benefit plan or insurance carrier. The provider may try to over-bill these institutions. Not all instances of health care fraud are against patients.

There are many different types of health care fraud schemes. However, not every provider that is accused of being fraudulent deserves criminal charges.

No Comments

Leave a comment
Comment Information

Honors and Memberships

Super lawyer American college trial lawyers The national trail lawyers AV Preeminent
Contact us

contact our law firm

If you are facing a criminal charge or securities dispute, it pays to have experienced lawyer on your side. Contact us today online or by telephone at 917-639-5370 to speak with an experienced New York City defense lawyer.

Bold labels are required.

Contact Information

The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.


Privacy Policy

New York
Bachner and Weiner PC

New Jersey
Bachner and Weiner PC

New York Office
39 Broadway, Suite 1610
New York, NY 10006

Phone: 917-639-5370
Phone: 212-344-7778
Fax: 212-344-7774
New York White Collar Crimes Office

West Caldwell Office
New Jersey Office
175 Fairfield Avenue, Suite 3D
West Caldwell, NJ 07006

Toll Free: 877-388-6461
Phone: 212-344-7778
Fax: 212-344-7774
Map & Directions