Health Care Fraud

Health care fraud, a form of white-collar crime, costs the U.S. government and taxpayers billions of dollars each year. This common type of fraud typically involves the filing of false medical claims. It increases costs for medical providers and patients, and it harms the long-term viability of programs like Medicare and Medicaid.

The experienced attorneys of Davis Levin Livingston work with health care fraud cases in a number of areas, including:

  • Medical equipment fraud, involving charges for unneeded products.
  • Services not performed, including billing of insurers for medical services that were not rendered.
  • Use of unlicensed medical staff to treat patients.
  • Medicare fraud, which frequently targets senior citizens. For example, seniors may be offered free medical products if they provide their Medicare numbers. Con artists may forge signatures to bill Medicare and never deliver the promised merchandise.
  • Billing for non-covered services as covered services.
  • “Rolling lab” schemes, in which individuals are given unnecessary tests that are billed to Medicare or private insurance companies.
  • Prescription medicines obtained illegally and sold on the black market for a profit.
  • Loaning out or using someone else’s health insurance card.
  • Filing of duplicate insurance claims for the same service.
  • Illegally altering medical records.
  • Provision of false information when applying for medical programs or services.

How Health Care Fraud is Committed

Criminals use a number of methods for illegally gaining use of patients’ insurance information. They may induce patients — with money or gifts — to visit a specific location such as a clinic, where medical information is gathered. In some cases, they collect information at health fairs from individuals who participate in free health screenings. They sometimes persuade health care workers to copy patient information for use in fraud schemes, and they may purchase information from others involved in fraud.

Consumers should be aware of the potential for fraud when dealing with health care providers online and in their local areas.

Costs of Health Care Fraud

Medical fraud presents a growing threat in the United States, as the FBI notes, and uncovering it is critical for the health of the national economy and individual citizens. With expenditures exceeding $3 trillion annually and outpacing inflation, the medical field serves as an attractive target for criminals.

Federal officials estimate the costs of health care fraud at about $80 billion annually, with most being passed on to consumers in the form of higher insurance premiums and higher costs for medical services.

Consumers Can Protect Themselves

To guard against potential fraud, consumers should always review their “explanation of benefits” forms they receive in the mail from insurance companies. The forms provide details of services and medical supplies provided in a patient’s treatment. Patients who suspect improper billing should contact their insurance company and should consult an experienced health care fraud attorney if they suspect illegal activity.

In addition, consumers should take the following steps to protect themselves from fraudulent activity:

  • Guard insurance cards and the information they contain. Only give insurance information to valid medical providers, and be especially cautious if free services are provided in exchange for the information or if offers are made by telemarketers.
  • Check carefully when receiving medical equipment or supplies to ensure that the items delivered match what was ordered.
  • Do not give a medical provider blanket authorization to bill for any services received.
  • Take note of surroundings in medical facilities, and be wary if typical medical equipment and information-gathering procedures are absent.
  • Don’t accept unnecessary gifts — including equipment or products — from visiting health care providers.
  • Do not sign blank insurance forms.
  • Ask medical providers for information about total and out-of-pocket charges.
  • Keep records of any appointments with health care providers.
  • Be aware if your doctor has ordered medical equipment on your behalf.

Contact Experienced Health Care Attorneys

When health care fraud occurs, consumers bear the brunt of the cost. In fact, experts estimate that 10 cents of every dollar spent on medical care pays for fraudulent claims. Prosecution of health care providers engaged in fraud can result in serious consequences, including steep fines, possible incarceration, and loss of medical licenses.

If you believe you may have been the victim of health care fraud, including improper use of your medical insurance credentials or illegal billing of your insurance company, contact the experienced attorneys at Davis Levin Livingston at (866) 806-4349 for immediate assistance.