The healthcare industry is a multi-billion dollar business in the United States. Individuals, organizations and governments funnel billions of dollars through the system each year, and with that much money on the line, it’s no surprise that healthcare fraud is a big problem. Therefore, it’s important that you understand the different types of scams you may encounter to protect yourself and your loved ones in California.
Fraudulent billing occurs when providers submit false or inflated claims to insurers for medical procedures that weren’t actually provided, goods or services that were never received or a higher level of service than what they gave. It can also occur when providers submit duplicate claims or fictitious information to increase payments.
Kickbacks and rebates
Healthcare providers may also hide kickbacks or rebates behind legitimate business transactions, such as discounts on pharmaceuticals, equipment purchases, referrals or other services. A provider might accept an incentive from a drug company in exchange for prescribing a particular medication. Or, the provider could pay a referral fee to another doctor for referring patients to their practice.
Self-referral arrangements occur when a health care professional refers beneficiaries to receive medical treatments from a clinic owned by the same health care practitioner or by another practitioner who shares financial relationships with them. This is among the most common white-collar crimes because it presents an inherent conflict of interest.
There are also instances when medical professionals write and fill out false or fraudulent prescriptions for drugs that the Food and Drug Administration (FDA) hasn’t approved yet. Sometimes, these medications may be counterfeit, substandard or unsafe for patients.
If you think you may have been the victim of healthcare fraud, then it’s important to report it immediately. You should contact your insurer and get in touch with law enforcement if necessary. In some cases, victims may be able to file a lawsuit to recover financial damages or take other legal action against the perpetrators of healthcare fraud.