Preventing Health Care Fraud and Abuse

Health care fraud is a key driver of rising health care costs. About 3% of all health care spending — or $68 billion each year — is lost to health care fraud. There are a few types of health care fraud including:

  • Medical Identity Theft. This is the misuse of a person’s medical identity to obtain health care goods, services or funds.  This can include fraudulent prescriptions, billing for services that were never provided or referring patients for unnecessary services.
  • Upcoding. This is when the provider bills for a service of higher complexity than the service that was provided or documented.  For example, a supplier may bill for motorized scooters, but supply manual wheelchairs.
  • Billing for Services not Furnished
  • Others can be found here

Here are some things you can do to help prevent health care fraud and abuse.

  • Review your health care charges. Look over your Explanation of Benefits from your insurer and receipts from your doctor or pharmacist to make sure the right dates of service are recorded, and that you are billed for the right services or medications. If you have questions regarding your treatment codes, contact your doctor to review.
  • Protect your health information. Keep your insurance card and health care records in a safe place at all times.
  • Monitor your medications. Count your pills each time that you pick up a prescription.
  • Report suspected fraud and abuse as soon as possible

You have a right to all of your health care charges, including codes to verify information.  Make sure to only share your insurance information with reputable medical facilities.  It is normal for a medical facility to need your social security number for billing purposes.

If you have any questions regarding insurance, billing or coding, please do not hesitate to contact our office.  Our doctors and staff are heavily trained in billing, coding and insurance procedures and would be happy to answer any questions.

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