What is health care fraud?
care fraud is the misrepresentation of health care transactions
by any party, including health care providers, employer
groups, or health care plan members. Health care fraud
typically involves billing for services not rendered,
double billing, and submitting improper cost reports.
Currently, it is estimated that health care fraud costs
Americans approximately $100 billion per year.
These massive losses are one reason Americans are so
disgruntled with the current health care system.
How does health care fraud affect
care fraud affects everyone. Due to the amount of money
lost every year to fraudulent claims, the cost of health
care is rising. This means that employers must pay higher
health insurance premiums and that members must pay
more for health care benefits. Due to this cost increase,
many people are not able to obtain the affordable health
care that they want or need.
What happens to someone who commits
health care fraud?
Individuals convicted of this crime
face imprisonment and substantial fines. Numerous state
and federal laws and regulations exist that penalize,
fine, and sanction individuals or groups engaged in
health care fraud. The consequences for committing fraud
include a mandatory exclusion from Medicare and Medicaid,
and offenders are often required to pay very high monetary
What are the most common types of
health care fraud?
Provider Fraud: Typical provider fraud
involves improper billing, the performance of unnecessary
medical services, and the misrepresentation of information.
Member Fraud: Typical member fraud
involves using someone else's coverage, filing false
claims, or misrepresenting bills, invoices and receipts.
Employer Fraud: Typical employer fraud
involves the false representation of an employer group,
the enrollment of ineligible individuals, and the
falsification of important dates and information.
What can I do to avoid health care
The most important thing you can
do is stay informed. Ask your health care provider questions.
Keep records of all your statements and transactions.
Be careful when you disclose your insurance information.
Almost every health care plan has a customer service
department set up to answer your questions on any subject.
Take advantage of this service.
you are aware of individuals or entities involved in
health care fraud, you may be entitled to a reward under
the False Claims Act. To have an attorney answer your
questions about health care fraud or the False Claims
Act, please contact The
Schofner Law Firm.