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Healthcare Fraud

Healthcare fraud is far from a victimless crime. It is a white-collar crime, one involving business and government professionals, usually in an office setting. Yet this type of fraud doesn’t just hurt major companies – it hurts the little people. The customers are the ones that end up paying for these claims. The prevalence of healthcare fraud in the U.S. has raised the costs of healthcare for all Americans by about 10 cents for every dollar. Detecting and putting an end to healthcare fraud is critical to the well-being of citizens and the health of the economy. If you suspect this wrongdoing, speak to Butler Wooten & Peak LLP. Our consultations are free and completely confidential.

Types of Healthcare Fraud

Healthcare fraud comes in many shapes and forms – some more harmful than others. Healthcare practitioners, members, and providers may all be behind fraudulent schemes in order to make a profit illegally. As a patient, beware of medical practitioners and providers that handle your healthcare via the internet. Know whom you are dealing with, and do not give your medical information online. Practitioners can commit healthcare fraud in a number of ways:

  • Asking for patient information to obtain a “free screening”
  • Billing providers for care the practitioner never actually provided
  • Filing duplicate claims for the same service
  • Billing for services the provider doesn’t cover as a “covered service”
  • Modifying medical records and dates on documents
  • Reporting diagnoses or treatments incorrectly to increase payment
  • Prescribing unnecessary treatment to patients
  • Illegally charging higher costs for services
  • Issuing unnecessary prescriptions
  • Providing tainted prescription drugs and medications
  • Promoting a drug for a use the FDA has not approved (illegal marketing)
  • Misrepresenting dates or locations of services
  • Misrepresenting who provided the services
  • Waiving deductibles and co-payments without permission
  • Accepting kickbacks or bribes for engaging in fraud schemes
  • Falsifying a patient’s diagnosis to justify unnecessary treatments
  • Billing each step of a procedure as if they were separate procedures

Healthcare practitioners can put their patients through a series of tests, scans, and x-rays they don’t even need, in order to turn a profit. Some will stop at nothing to carry out healthcare fraud schemes, with no concern for patient well-being. In other cases, it is the members who commit the fraud. They might give false information to the provider, forge prescriptions for drugs, sell prescription drugs on the black market, or use someone else’s insurance card for services. These schemes ultimately make insurers and taxpayers pay for fraud claims.

Don’t Be Afraid to Blow the Whistle on Healthcare Fraud

Healthcare fraud costs America billions of dollars every year. False billings, upcharging for drugs, and administering unnecessary tests can add up to immense expenses, for which taxpayers ultimately foot the bill. The consequences of healthcare fraud are real and devastating – it can lead to patients in the emergency room, involved parties incarcerated, and even deaths due to illegal drug activity. If you have any information about healthcare fraud in your industry, your place of work, or in your social circle, speak to an attorney. You can help put a stop to this invasive problem in the country.

Rooting out healthcare fraud takes action from courageous, taxpaying Americans. Someone involved in healthcare fraud, or someone who catches wind of the scheme, has a duty to speak out. Unfortunately, many individuals are too afraid of retaliation to say anything to the government about fraudulent actions. Many people don’t realize that the law protects “whistleblowers” from retaliation, and even rewards them with compensation when they help shut down a fraud scheme. If you have information about healthcare fraud, don’t be afraid to do the right thing. Contact Butler Wooten & Peak LLP to start the discussion today.