Orlando Healthcare Fraud Lawyer

Types of Healthcare Fraud

Fraud is an umbrella term for any deceptive scheme intended to enrich a doctor or other person at the expense of an insurance company or another entity. Some specific kinds of healthcare fraud include:

• Kickbacks: Private companies, as opposed to individual doctors, often perpetrate these frauds. It’s illegal to offer anything of value to a doctor in exchange for making a certain decision or pushing a certain product.
• Unnecessary Services: These frauds usually involve diagnostic and other tests. It’s often difficult to distinguish among things like ordering an unnecessary test, being overly cautious, and covering all the bases. Only the first act is illegal, although it’s very similar to the other two.
• Improper Prescription Drug Charges: Many pharmacies offer informal, in-store discounts to people who don’t have Medicaid or Medicare. But they bill the government for the full price. Federal laws require Medicare/Medicaid and non-Medicare/Medicaid customers to pay the same price.
• Non-Physician Services: Government and private insurance companies usually require doctors to perform certain examinations and other services. It’s illegal to delegate these tasks to nurses or patient care technicians. These charges only hold up in court if the doctor intended to save money. They may not apply if the doctor intended to save time.
• Upcoding: Medical coders translate physician services to certain insurance codes. Sometimes, these coders intentionally enter the wrong data to enrich the medical practice. But sometimes, they simply make mistakes.