Health care fraud is a growing concern in the medical community. According to Microsoft in Health, the health care industry loses to fraud, waste and abuse more than 455 billion dollars each year. Most medical and health care providers in the Houston area are ethical and honest. However, some are not. There are many factors that lead to medical facilities and their personnel violating local and federal laws and health care regulations.
Health care fraud drives up medical costs for the public. Providers must charge more for their services to offset their losses. Some professionals willing break the law for personal gain. Some types of fraud, such as certain errors in medical billing and identity theft are not done intentionally. Incidents of fraud that are intentional pose a significant risk to providers and patients. Common types of health care fraud include:
- Billing for services that were never rendered
- Billing for more expensive services than were administered
- Duplicate billing for services
- Performing excessive and unnecessary medical procedures to boost profits
- Submitting fragmented medical claims that should be bundled together
The above list details some of the numerous ways fraud occurs in the medical community. The penalties include fines, sanctions, jail time and more.
Health care providers and payers are held to high standards. They should be honest, have integrity and use a system of checks and balances to ensure the accuracy of their practices and services. They should also perform routine audits to reduce the number of issues that can occur to decrease their risk of intentional and unintentional fraud.