There are different categories of Medicare fraud to be aware of. If you see any of these varieties of activities, be sure to contact a lawyer who can counsel you how to proceed:
False billing
False billing is one of the most egregious areas of health care fraud. Hospitals and physicians may bill Medicare for treatment, drugs or gear that was never prescribed in the 1st place. A real example of this is if you order nonessential medical kit like a wheelchair. A doctor might order one of those for a person who is in no need of one. They'll then look to bill Medicare for that wheelchair at a seriously inflated cost that equates to regularly 3 or 4 times the amount it would usually cost. The organisation would then pocket the profit.
Health Care Identity Fraud
The main culprit in this arena of medicare fraud could be I. D. theft. According to Louis Saccochio who is the director of the NHCAA (State Health Care Anti-Fraud Association), a govt. watchdog in which members include law enforcement personnel, regulatory agencies and insurance carriers, he maintains that after closely inquiring into the main reasons why fraud and abuse in medical care exist, discoveries show that this sort of health fraud accounts for 60 % of the total.
Medical care identity fraud is big business and occurs when somebody sells medical records containing all of the info about a specific patient to organised wise guys, who will use it for other criminal activities. Obviously medical records should be confidential and not something that any ordinary 'John Doe ' can get their hands on.
So what occurs typically is that somebody who has bonafide access to these records, such as an Infirmary Administrator maybe a Surgeon themself will sell this info on to the criminal groups for a tidy profit. In many cases the law breakers would then sell these records on to those who are uninsured and are completely desperate to receive hospital therapy. Of course these would be sold on for very high prices.
False billing
False billing is one of the most egregious areas of health care fraud. Hospitals and physicians may bill Medicare for treatment, drugs or gear that was never prescribed in the 1st place. A real example of this is if you order nonessential medical kit like a wheelchair. A doctor might order one of those for a person who is in no need of one. They'll then look to bill Medicare for that wheelchair at a seriously inflated cost that equates to regularly 3 or 4 times the amount it would usually cost. The organisation would then pocket the profit.
Health Care Identity Fraud
The main culprit in this arena of medicare fraud could be I. D. theft. According to Louis Saccochio who is the director of the NHCAA (State Health Care Anti-Fraud Association), a govt. watchdog in which members include law enforcement personnel, regulatory agencies and insurance carriers, he maintains that after closely inquiring into the main reasons why fraud and abuse in medical care exist, discoveries show that this sort of health fraud accounts for 60 % of the total.
Medical care identity fraud is big business and occurs when somebody sells medical records containing all of the info about a specific patient to organised wise guys, who will use it for other criminal activities. Obviously medical records should be confidential and not something that any ordinary 'John Doe ' can get their hands on.
So what occurs typically is that somebody who has bonafide access to these records, such as an Infirmary Administrator maybe a Surgeon themself will sell this info on to the criminal groups for a tidy profit. In many cases the law breakers would then sell these records on to those who are uninsured and are completely desperate to receive hospital therapy. Of course these would be sold on for very high prices.
About the Author:
Health insurance fraud can be because of false billing during this example consulting to a lawyer can help you. In such example you are a whistleblower who knows the illegal acts within your company there are laws that may defend you. Read on the manuscript of Raiden Dampier about the health care identity fraud.
