Health Care Fraud Patterns to be Aware of

Estimated at costing $54 billion annually, health care fraud increases health care costs for insurance companies, which get passed on to policyholders in higher premiums. Some recent patterns of health care fraud include:

• Billing for “free” screenings and services not provided: The provider is accused of billing for “free” gait testing, office visits and orthotics. The doctor offers these services to unsuspecting individuals and subsequently bills their insurance company at exorbitant rates for these “services.” Individuals usually have no particular health complaints and often “free” items were not medically necessary or ever provided.
• Unnecessary diagnostics: Several scanning facilities, often in collusion with doctors, are alleged to be part of a scheme to artificially increase the number of patients receiving scans, billing for unnecessary services to dramatically increase their income.

Individuals can help avoid unnecessary diagnostics by asking why a specific test is needed, who is providing it, and how results will be used to manage their care. By law, doctors must tell you if they have a business interest in the entity performing the procedure.