Healthcare Fraud – Medical Fraud

If you are like most people you have never thought about healthcare fraud before, but it’s out there and thriving. There are a lot of different people who are committing healthcare fraud everyday, people ranging from patients, to doctors, and even pharmacies. Healthcare fraud affects everyone because the costs of those that are scamming the system have to be absorbed by the average consumer. In short, healthcare fraud is partially responsible for your increasing costs of healthcare and health insurance, and these increases in fees is making healthcare very expensive for all, and unaffordable for many. Healthcare shouldn’t be out of our reach, but because of healthcare fraud it is becoming out of reach for a growing number of people.

The Affects of Medical Fraud

Did you know that healthcare fraud directly affects you? In fact, it has been estimated that healthcare fraud costs Americans about $54 billion a year, which is a staggering number! The way that you pay for this fraudulent activity is through increased healthcare costs. The result is that many people cannot afford regular healthcare, which leads one to the realization that this fraud actually affects the overall health of the average American.

There are many types of healthcare fraud and they are committed by a wide variety of people. When we talk about healthcare fraud we are talking about actions such as:

  • Billing for services that have not been provided
  • Billing for a service that is covered by insurance when it was not the procedure provided
  • Billing for unnecessary treatments
  • Billing for services that have a higher reimbursement rate
  • Billing for separate services that could be bundled together
  • Billing for services that were not provided to the named individual
  • Intentionally receiving numerous prescriptions from different doctors
  • Adding people to your healthcare plan that do not qualify

As you can see, there are a lot of different things that qualify as healthcare fraud, and this is by no means an exhaustive list. There are new schemes taking place all the time, and many of them slip through the cracks. As a consumer, you need to think about what you can do to fight back against healthcare fraud.

Fighting Back Against Healthcare Fraud

Keep tabs on your healthcare card at all times. Many people will use the healthcare card of another individual if they get their hands on it. You should also make sure that you know what your benefit coverage is, and also look at statements to ensure that the benefits that were submitted by a caretaker were actually done. You also need to be careful who you share your health insurance information with. You need to be sure that you trust the doctor and their office staff before you give them your information. Also be sure that you understand the co-payments that you may or may not be making, as it is necessary that you make your co-payments and it is never acceptable for someone to waive your fees.

As you can see, you need to be guarded with your healthcare information. Those that are committing healthcare fraud are often those that you would least expect. We all believe that a person who works in the healthcare industry would never defraud the system, but it has been seen time and time again that this is just not the case. There are people in the doctor’s offices, the doctors themselves, patients, and even pharmacy workers that are working to defraud the system every day. You need to do your part to be sure that you are not apart of the fraud network.

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1 thought on “Healthcare Fraud – Medical Fraud”

  1. I recently went to an ortho clinic for fractured ankle. They require $300.00 up front (I don`t have any insurance) and require you to apply for and accept a “health care credit card” which I didn`t want. The Dr. spent 15 minutes lokking at 2 xrays from the hospital, wrapped my ankle with Ace bandage. I received their bill today for over $1,300.00. Listed costs were for “treatment to a closed fracture” ! A 1300.00 dollar Ace Bandage!!! I have got to have someone look into this but I don`t know where to begin. Any suggestions?


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