Common types of healthcare fraud

On Behalf of | Mar 15, 2023 | White Collar Crime

Healthcare fraud is common.  It occurs in various ways. Healthcare providers may face fraud charges because they purposely take illegal actions. However, simple mistakes or inattentiveness may also result in charges.

Providers are not the only ones who might face fraud convictions. Patients and other may individuals also take part in abusing the system.

Fraud by healthcare providers

Many cases of healthcare fraud stem from the actions of medical and other healthcare providers. The Centers for Medicare and Medicaid Services discusses some of the common examples of how such frauds are committed:

  • Billing for tests or exams that never occurred
  • Billing for a higher-level service, even though a lower-level services was performed
  • Billing for equipment or services that the patient did not need
  • Receiving or offering kickbacks
  • Misusing an individual’s medical information and identity
  • Submitting bills for individual procedures or tests, instead of bundling them, performed at the same time

Fraud by individuals

Providers are not the only ones who commit fraud. The Federal Bureau of Investigation discusses that prescription drugs are one area in which people often break the law. They may forge prescriptions, get the same prescription from multiple doctor’s offices or sell their own prescription medication.

Another form of fraud occurs when people allow others to use their health insurance, or they use someone else’s, to obtain equipment, medication or services. Illegal or bogus marketing is fraud. Fraud also occurs when someone bills for healthcare services, but does not have a medical license.

A conviction for fraud comes with serious consequences, including high fines and prison time. If the fraud resulted in a patient’s injury or death, the penalties are even stiffer.

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