Ways to Prevent Health Fraud Scams

Introduction

Nowadays fraud is found everywhere. Health fraud scams are designed to trick consumers into spending money on goods or services that are actually ineffective, useless, or harmful to their health. Healthcare fraud and scams are deliberate misinterpretations or deception of services that result in unauthorized reimbursement. There are many forms of fraud. The most common ones are:

• Drug fraud and abuse.

• Home health care fraud.

• Health insurance and medical billing fraud.

The consumer protection division aims to help educate consumers on how to recognize fraud and scams and file a complaint with the appropriate agency.

What Is Health Fraud?

Health fraud scams are deceptive tactics used to trick consumers into purchasing ineffective, unproven, or even hazardous goods and services. These frauds frequently prey on vulnerable groups like the elderly, the chronically ill, or people with limited access to healthcare, and usually involve making false claims about the efficacy of a good or service while using unproven ingredients or techniques. They affect everyone, including individuals, business and cause billions of losses yearly, which can raise health insurance premiums, increase taxes, and expose one to unnecessary medical procedures. Patients, medical providers, and those who intentionally receive the healthcare system to deceive unlawful benefits or payments can commit healthcare fraud. The FBI (Federal Bureau of Investigation) agency is the primary agency investigating healthcare fraud for private and federal insurance programs. The FBI investigates the crimes in partnership with:

• Heathcare and fraud prevention partnership.

• Federal, local, and state agencies.

• Various insurance groups include National Insurance Crime Bureau, National Health Care Anti-Fraud Association, and insurance investigative units.

One should report if they encounter the following frauds:

• Billing for services that are not necessary.

• Billing for services that have not been rendered.

• Misrepresentation of the type of service provided.

• Misrepresentation of the individual rendering the service.

• Asking for money or reimbursement for services rendered for procedures related to other procedures performed on the same service date.

• Asking for reimbursement for services that are correctly billed at a lower rate.

What Are Health Fraud and Abuse Laws?

The federal laws are:

• Anti-Kickback Statute.

• False Claims Act.

• Physician Self-Referral Law.

• Social Security Act includes the Exclusion Statute and the Civil Monetary Penalties Law.

• The United States Criminal Code.

What Are the Common Types of Health Care Fraud?

1. The common types of fraud committed by medical providers are:

• Double Billing - Double billing is practiced by submitting multiple claims for the same service.

• Unbundling - Unbundling is the submission of various bills for the same service. It is when the billing for a more expensive treatment or service is done than the patient received.

• Phantom Billing - Phantom billing is done for supplies or service visits the patient never received.

2. The common types of fraud committed by patients and other individuals are:

• Identify Theft and Swapping - In this type of fraud, the person uses another person's health insurance or allows another person to use it.

• Impersonating a Health Care Professional - Billing or providing for health care equipment or services without a license.

• Bogus Marketing - Convincing and asking people to provide their personal information and health insurance identification number to bill for non-rendered services by stealing their information and identification to enroll themselves in the fake benefit plan.

3. The typical fraud involving prescriptions are:

• Diversion - Diverting or distracting legal drugs for illegal use like selling prescription medication.

• Forgery - Using or creating forged prescriptions. Visiting multiple providers to get prescriptions from medical offices that engage in unethical practices.

How to Avoid Health Care Fraud?

Some tips to avoid healthcare fraud are:

• Always beware of free medical services. If they ask to provide health insurance information for a free service, that service is not free and could be fraudulently charged to the insurance company.

• Always protect health insurance information. Avoid sharing personal information with others. Likewise, please do not give insurance information for others to use, and be mindful while using it when using it at a pharmacy or hospital.

• Explanation of benefits (EOB) should be checked regularly. So the location, dates, and service bill matches what one received. In case of any concern, contact the health insurance provider.

• Validate all ID cards before rendering services.

• Check the accuracy while submitting the claims and bills for service rendered.

• Submit appropriate treatment and referral forms.

• Report if one suspects any fraud by contacting the special investigating unit.

• Report the stolen or lost fraudulent prescriptions or prescription pads.

• Make sure to avoid unnecessary medical treatments or drug prescriptions.

What Are the Tips for Preventing Fraud Scams?

There are several things one can do to prevent medical fraud:

1. Protect the Health Insurance Number - Do not share the health insurance number with everyone. Share it only with one’s doctors or other healthcare providers. Be alert when others ask for a health insurance number or promise to offer free services when one provides them with the health insurance number.

2. Know the Health Insurance Coverage Rules - Be careful if the provider tells that there are other ways to get health insurance to cover a service that is usually not covered.

3. Be Skeptical - Do not pay for services that do not sound medically necessary. Use one’s judgment and refer to the health insurance coverage rules.

4. Do Not Accept the Services One Does Not Need - Get a second opinion if the provider is pressurizing for a particular test or any other service one feels is unnecessary.

5. Keep Record - Keep a record of the health care appointments and services.

6. Report Fraud - If one suspects fraud, report it immediately or contact the health insurance provider.

Conclusion

Most doctors and health care providers try to work ethically by providing high-quality care. However, healthcare fraud has become a significant issue because of the rising cost of the industry. So before taking an unproven or unknown treatment, speak to the doctor or healthcare provider, especially when taking prescription drugs.