What You Don’t Know About Healthcare Fraud Could Affect More Than Your Health
Common Types of Healthcare Fraud
What Is Healthcare Fraud?
There are many types of healthcare frauds, some obvious and some so disturbing you may think twice before going to your next doctor’s visit. Not to worry, armed with this information and knowledge, you will know what to look for and become the best advocate for your own health.
Healthcare fraud is a crime of theft and a crime of deception. Due to this deception, the fraud looks like the provision of regular healthcare services. It may not be apparent to the naked eye that something is actually seriously wrong. As we dive into healthcare fraud investigations, we come across a variety of common schemes and trends.
Healthcare fraud has been a continuing and ongoing issue, the advent of Medicare and Medicaid have unfortunately made it possible for physicians to engage in this type of abuse more than ever before, leading to the beginning of the fraud epidemic as we know it today. Healthcare professionals are taking advantage of innocent people and their lack of knowledge in this area, causing healthcare fraud to progress and become more prevalent.
Most Common Types Of Healthcare Fraud:
Money and Greed Can Be More Important Than Your Well-Being.
Billing Scam
The first and most common type of healthcare fraud is billing for services not rendered. It’s as simple as billing for things that never occurred such as a wheelchair or back brace that the patient never received. It’s something so easy for us to miss as we don’t tend to look at our medical bills and observe them as thoroughly as we should. Make no mistake, an added wheelchair to your insurance bill could increase your chances of your coverage being rejected should you ever truly need one. And it won’t even be your fault.
Over Billing for inflating services
Another very common type of healthcare fraud is inflating services. For instance, a patient will get their blood drawn for some lab work, but in addition to the tests that actually occurred the lab or the provider will bill for additional tests that didn’t actually happen in order to inflate the reimbursement for Medicare or Medicaid and increase their profits.
Unnecessary Medical Services
The misrepresentation of services happens all too often and this is seen through non-covered services that are instead billed as cover services, such as physical Therapy. In the world of pharmaceuticals, expensive drugs are billed and not dispensed and this follows to medically unnecessary services such as DME supplies (back braces, knee braces, or neck braces). And once again, lowering your chances of coverage should you ever truly need one. Almost sounds hard to believe, right?
The truth is, we are being over tested and over treated and it’s affecting us financially and physically. Many of these overused procedures and services can even cause potential harm to our bodies, such as CT scans and X-rays as they expose you to unnecessary radiation.
Healthcare fraud is ranked as one of the most prosecuted crimes, according to the FCA (Federal False Claims Act) resulting in billions of dollars on behalf of taxpayers from dishonest hospitals, pharmacies, doctors, and pharmaceutical companies.
These services will show up and become part of your permanent medical record, and you could be receiving care you don’t need.
Most of the procedures that are most commonly unnecessarily used are:
- EKG’s ($175-$299)
- Imaging tests performed on the lower back ($500-$1,000)
- MRIs and CT scans for headaches ($1,200-$2,000)
- Bone density scans ($100-$383)
- Antibiotics for sinusitis ($200-$400)
- PSA tests for prostate Cancer ($40-$150)
- Mammography for breast cancer ($449-$600)
Above are only some of the thousands of medical procedures that are being over prescribed for the sake of profits. Before you agree to these kinds of procedures, be mindful if it is absolutely necessary, or seek a second opinion.
How To Avoid Healthcare Fraud
The first step to avoiding healthcare fraud is knowing what to look for. There are many types of healthcare fraud, but the most frequent and costly is fraud committed by service providers, such as doctors, nurses, equipment providers and pharmacists. Think of anybody who orders or provides healthcare services, supplies or treatments. It’s hard to believe, but the people we depend upon and trust the most can be the ones responsible for these types of crimes.
First and foremost, you need to look at your medical bill and observe the list of what items and services your insurance is covering. The date of the service should line up with the date you were last seen by your provider. Try to recognize your doctor’s name on the bill to confirm that the provider’s name is in fact one of your doctor’s.
Keeping track of your medical bills is crucial, but it’s easier said than done. Especially when most of the medical terms are difficult to understand resulting in us overseeing them as we skim through our medical bill.
Found Me will help you stay safe from fraudsters
The things and people you love can act as the angel on your shoulder you need to help you keep track of your medical records. FOUND ME offers bracelets, labels and medical cards with a QR code that in case of emergency can be scanned and provide first responders with your medical records and history.
Furthermore by scanning the QR code, 5 emergency contacts can be notified and a confidential chat or video chat can be started between first responders and emergency contacts.
FOUND ME app can also be the safe place where you can keep all of your important medical records and information safe, so you can securely access them wherever and whenever you need them (date of a procedure, time of the procedure, list of services, treatments and drugs, and name of your provider…) And being aware that carrying any kind of personal information could be dangerous, FOUND ME has ways to help you protect them:
- The app is password protected.
- By keeping your medical information on the FOUND ME app you do not have to carry a physical card in your wallet.
- Medical profile release: if you wear a FOUND ME bracelet or medical tag, you can require your emergency contacts to release your medical info to first responders only after confirming the emergency through the app.
- You can block your medical identifier (bracelet, card, tag…) any time through the FOUD ME app, so if you lose your bracelet or medical card and someone scans it, nothing will appear.
Impacts of Healthcare Fraud: Physical Harm, Financial Harm
Medical tests and producers are not a pleasant experience. They’re stressful and scary. Blood draws, biopsies, and MRI scans of the brain and body are being used for the sole purpose of profit. Patients who fall victim to these scams can also face financial risks as well as risks to their benefits.
Fraudulent billing directly affects both cost and quality and is reflected in higher premiums, more expensive services, and potential exposure to unnecessary procedures.
Typically, many insurance benefits have limits, and when those limits are overused in the eye of your insurance, your risk of being denied can be much higher leaving you in trouble if something serious does happen. This can cause real issues for the patient’s benefits should they really need them at a later point in time.
Being scammed is never fun, especially when it comes to your health and it’s happening from the one place you’d least expect. Due to these unnecessary tests and examinations, there has been a study reporting an oncologist falsely diagnosing cancer and giving patient’s radiation therapy as well as chemotherapy. And all in the eyes of greed and money.
What To Do If You’ve Fallen Victim To Medical Fraud
If you have fallen victim to medical fraud, you are not alone. The National Health Anti-Fraud Association estimates that health care fraud costs the nation about $68 billion annually.
Here are some ways you can ensure you don’t fall victim to such a heinous crime:
- Validate all member ID cards prior to rendering service.
- Be sure to be accurate when submitting bills or claims for services rendered.
- Submit referral and treatment forms.
- Avoid unnecessary drug prescriptions and medical treatment.
You Don’t Have To Be A Victim Of Healthcare Fraud
Learning about fraud and scams can be nerve-wracking, it definitely was for me. Educating yourself on the many different ways of any type of fraud can help you avoid it from happening to you. You’re in the right place, and you’re doing your homework. With this knowledge, and these tips, you can fight against healthcare fraud and those around you from falling victim.
To ensure protection and gain better knowledge and track of your medical records, visit FOUND ME to learn more about everything it has to offer.
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