Health Care Fraud
Health care fraud and health insurance fraud is an attempt to file incorrect and dishonest health care claims, and turn over a profit. While it is not an Internet-specific type of fraud, this scam is more easily done on the internet through randomly generated emails, websites that appear legitimate and advertisements placed on Internet sites like Craigslist.org that target individuals looking for health care services.
Health care fraud can be committed by patients who sell prescription mediation they receive that is covered by their health insurance, transportation benefits for purposes that are not medical, or write false information on a medical document or application. Practitioners also commit fraud such as billing for services they did not provide their patients, or filling duplicate claims along with waiving a patient's co-pays. In fact is has become so common, that approximately 10% of money spent on health care is for fraudulent health care claims.
The reason this type of fraud often goes undetected is because of the laws behind when insurance companies pay claims. By law, a health insurance company must pay a legitimate claim within 30 days. If a claim seems inaccurate, the FBI and Office of the Inspector General do not have enough time to investigate it before the claim is paid. Patients who are caught committing health care fraud are subject to having their health care services terminated and numerous fines. For practitioner it tends to be more severe and may include incarceration, fines, and the loss of their medical certification.
Before preventing health care fraud, it is helps to know the various types of fraud that exist. This includes billing for services not performed, false information on a medical services application, a practitioner billing for a covered service when a non-covered service was done (like cosmetic surgery), filing claims for receiving medications you did not actually receive, forging bills and receipts, and using another person's insurance coverage.
As a consumer, the best way to avoid being caught up in health care fraud is to pay attention to the services you receive, and what you and your insurance company are billed for. If your practitioner is billing for a service not provided to you, or a different service is noted on the claim form, notify the authorities immediately as this is fraud.