You trust in your physician to take care of you. You trust them to prescribe medications, diagnose symptoms when you’re sick, and help you maintain a healthy lifestyle. But is your physician doing something else—something nefarious—that you don’t know about? He or she could be committing healthcare fraud—at your expense!

Healthcare fraud and abuse is on the rise in the United States. From physicians billing for services you don’t receive to performing unnecessary procedures, healthcare fraud and abuse takes a serious toll on your health and insurance. While most physicians do it to pad their revenue, these false claims, medical orders, and prescriptions put your life at risk.

Billing Schemes

Physician billing schemes are one of the most common types of healthcare fraud and abuse. He or she will bill your health insurance for services that were never provided and collect reimbursements for those services. This can occur in many ways, from a chiropractor billing your insurance for five visits when you only visited twice, to a physician charging you for expensive medications (like those used to treat kidney disease, cancer, or HIV) that you don’t need or didn’t receive.

Physicians have also been known to offer in-house CT machines and bill your insurance for scans that were never scheduled, let alone performed. Or a physician may perform a procedure to add a stent you don’t really need just to be able to bill your insurance and collect a claim. All of these extra charges and expensive services can impact both your insurance premiums and your health. The list of offenses goes on and on.

Upcoding For Higher Claim Amounts

Upcoding is another common form of healthcare fraud and abuse. This is a process where the physician charges for a higher service than what was actually performed. For example, you visit your physician for a routine office visit, which has its own code and reimbursement amount. However, your physician charges your insurance for an extended office visit, which costs more. According to recent statistics, making a simple code change like this could increase a physician’s revenue by $70,000. While his or income is increasing, yours is declining as you watch your insurance premiums steadily rise.

How to Fight Healthcare Fraud and Abuse

As frightening as all of this is, you can take steps to protect yourself:

• Review your billing statements and explanation of benefits (EOB) from your insurance provider. Verify that the charges made by your physician coincide with services, medications, and equipment you actually received. If you are confused, or feel you did not receive services, call the physician immediately!
• Annually request all treatment paid for by your insurance carrier. Compare them to your EOBs. If you find discrepancies, notify your carrier immediately.
• Request receipts when you pay at your physician’s office, as well as a receipt of all services performed.
• If you choose to pay cash for a service, watch for an EOB that the provider also charged your insurance provider.

Despite all you do to fight back against healthcare fraud and abuse, 10 to 30 percent of all medical patients fall victim. Get extra protection by hiring a fraud and abuse expert that specializes in safeguarding you from the consequences of these types of physician practices. Whatever you do, be proactive to prevent it from happening to you.

Make the Right Move

Consider signing up for an identity theft protection plan with a company like ID360, the only one managed by law enforcement that also restores your identity back to pre-theft status after it’s stolen. You can also discover helpful resources over at The Identity Advocate, and contact an experienced investigator to learn more about resolving healthcare fraud and identity theft. Fight back!

Related Articles:

• Is Your Medical Device Putting You At Risk For Identity Theft?
• The Right Prescription to Prevent Medical Identity Theft
• Are You At Risk For ObamaCare Identity Theft Scams?

Tags: health Care Fraud, health care theft, health fraud, healthcare abuse, healthcare fraud and abuse, Identity Theft, identity theft prevention, identity theft protection plan, medical identity theft, prevent healthcare fraud, prevent identity theft

This Entry was posted by Linda Vincent

Thursday, June 26th, 2014 / Fraud.
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