For many years, health care fraud has been a major problem throughout the United States. While many individuals and medical providers know what this looks like, some don't have nearly as much knowledge.
Fraudulent billing is exactly what it sounds like: This is when somebody, such as a medical provider, overcharges or fraudulently bills for services or goods that are not distributed or as described.
There are many examples of this, including but not limited to:
-- A supplier scheme in which Medicare is billed at an abnormally high cost.
-- Billing Medicare for more items than what was actually provided.
-- The use of a fictitious address in an attempt to hide illegal activity, such as fraudulent billing.
-- Closing and opening a business under different names as to avoid detection.
In addition to individuals, there are times when both providers and insurers seek ways to "game" the reimbursement system. Despite the fact that some of these people have a good name within the industry, it doesn't change the fact that an organization could get tied up in a fraudulent billing scam.
When it comes to health care fraud and fraudulent billing, there are time when people know exactly what they are doing. They make decisions that allow them to benefit financially.
Conversely, there are situations in which somebody makes an honest mistake. Even so, they can still be charged with a crime. If this happens, it's important for people to understand why they were charged, how they can clear their name and what they can do to avoid a serious punishment.
Source: FindLaw, "The Many Faces of Health Care Fraud," accessed March 24, 2017