There are many types of healthcare facilities in Texas. Each type of facility can have similar opportunities to misrepresent or deceive information in order to receive reimbursement. There are a few common types of healthcare fraud providers should be aware of.
The Texas Attorney General’s Office separates health care fraud between Medicare and Medicaid fraud, drug fraud and abuse, home health care fraud and health insurance and medical billing fraud. Incorrectly filing a Medicaid or Medicare claim can result in unentitled reimbursements.
Drug fraud and abuse focus on counterfeiting drugs, their pricing or failing to administer medication. Home health care fraud can combine both insurance fraud and drug abuse. It can also include failure to comply with requirements set by the government for running a home health care practice.
There are many types of medical billing and health insurance fraud that can result in greater reimbursements than the provider is entitled to receive. A few examples include waiving deductibles or copays, unbundling a procedure into stages, billing for unperformed services, accepting kickbacks and upcoding a service because it is more expensive than that performed.
The Texas Department of Insurance provides ways for people to report suspected insurance fraud. There is only a 30-day window to report fraud related to insurances. This includes providers trying to upsell unnecessary procedures and products or companies collecting data under as a health insurance company.
Some additional forms of healthcare fraud include collecting personal information through fake phone calls, marketplaces or insurance websites. These unsolicited phone calls, emails, personal visits and letters often pressure individuals to change insurance coverage.