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How do medical practitioners commit insurance fraud?

On Behalf of | Jan 18, 2022 | Medical Licensing

You go to extreme measures to protect your medical license and follow the law. If you face accusations of misconduct or committing a white-collar crime, you may not understand where the charges came from.

The Legal Information Institute explains healthcare fraud and how practitioners commit it. Determine if you broke the law accidentally to mount a solid medical license defense.

Examples of practitioners schemes

When medical practitioners commit healthcare fraud, they often do so for ill-gotten gains. One example of a practitioner scheme is receiving fully covered or subsidized medication a patient does not need to sell on the black market. Unscrupulous practitioners may intentionally bill patients for medical services that they did not receive or file multiple claims for a single medical service. Another example of a practitioner scheme that breaks the law is changing medical service descriptions, dates, or provider or member identities.

Double-check forms and documents before billing patients for services received. Billing for a service that insurance does not cover to make it look like a covered service qualifies as healthcare fraud. Another illegal practice is intentionally reporting medical procedures and diagnoses incorrectly to inflate payments. Each member of your staff must have a current license, and you cannot offer or accept kickbacks for referring members.

The effects of practitioner healthcare fraud

When medical practitioners commit fraud, customers are the ones who suffer and absorb the financial fallout. Those found guilty of illegal activity may face fines, incarceration or lose their license.

It makes sense to stay up-to-date on the latest healthcare fraud schemes. Staying well-informed may help keep you on the right side of the law.