Health Care Crimes

  • medical-appointment-doctor-healthcare-clinicHealth insurance Fraud: Insurance fraud happens when any act is committed with the criminal intent to fraudulently obtain some benefit to which a person is not entitled. It also happens when someone willfully denies some benefit that is due and to which an individual is entitled.
  • Medic aid providers include doctors, dentists, hospitals, nursing homes, pharmacies, clinics, counselors, personal care/homemaker chore companies, and any other individual or company that is paid by the Medicaid program. If a provider intentionally misrepresents the services rendered, and therefore increases their reimbursement from Medicaid, Medicaid fraud has occurred.[spacing size=”20px”]
    Medicaid fraud includes …[spacing size=”15px”]

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    [alist_item]Billing for medical services not actually performed, known as phantom billing[/alist_item] [alist_item]Billing for a more expensive service than was actually rendered, known as up coding[/alist_item] [alist_item]Billing for several services that should be combined into one billing, known as unbundling[/alist_item] [alist_item]Billing twice for the same medical service[/alist_item] [alist_item]Dispensing generic drugs and billing for brand-name drugs[/alist_item] [alist_item]Giving or accepting something in return for medical services, known as a kickback[/alist_item] [alist_item]Bribery[/alist_item] [alist_item]Providing unnecessary services[/alist_item] [alist_item]False cost reports[/alist_item] [alist_item]Embezzlement of recipient funds[/alist_item] [/arrow_list]