No industry is free from frauds or scams, including the medical industry. Even individuals who work in the industry might not be able to realize when such malpractices happen around them. Since scams normally originate from the top of an organization, people maintaining the books, filling out various forms, or performing data entry might be completely oblivious. Most likely, they’re completely unaware of the fact that they’re assisting to trick the government. Other individuals might suspect everything is not right but don’t have the courage to speak up since this might jeopardize their present jobs.
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In the medical sector, one common way used for scamming the government includes fraudulent Medicaid & Medicare billing. A variety of schemes can be used to accomplish this. Some of these are listed here.
Fake Patient Bills:
Here, a patient along with a medical expert come together to scam government officials. The patient provides their Medicare number while the doctor bills for procedures never required. This way, both the medical professional as well as the patient receive kickbacks.
Phantom Billing Scheme:
In phantom billing, a medical professional might be able to bill Medicare for tests or medical procedures which are never conducted. Besides, they might also bill for treatments, medical equipment or examinations that weren’t actually essential.
It involves submitting separate bills so as to get maximum repayment from Medicare. For instance, some panels of laboratory exams may be performed together so regularly that they produce their individual billing group. Billing every test individually would produce greater reimbursement which is against the law.
In upcoding, a medical professional deliberately utilizes higher-paying codes on the patient’s claim form so that they get reimbursement for device or procedure that might be more expensive as compared to the real one.
In conclusion, the best way of preventing such frauds is via education. It is also wise to go through a variety of helpful sources present online on this matter. You can also register yourself in a special ‘do-not-call’ registry in order to prevent harassing calls from telemarketers. This service is available totally for free at donotcall.gov website.