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5 Common Types of Healthcare Fraud

By Hager & Schwartz, P.A.

May 11, 2021

Healthcare Fraud Charges in Florida

Healthcare fraud is a financially motivated, white-collar crime. White-collar crimes typically involve deceit but not violence or force.

There are multiple, complex forms of healthcare fraud that both doctors and patients can commit.

1. Billing For Services Not Rendered

This occurs when a healthcare provider submits a claim for a visit that did not happen or supplies or services that weren’t used.

Not only is this practice financially deceptive, but it also creates a false medical history for the patient. The patient may have trouble getting disability or life insurance policies based on inaccurate medical records.

2. Misrepresenting Service Coverage

This type of healthcare fraud involves falsifying the service’s details to make it seem like a covered procedure when it was not.

This may occur if a doctor provides an experimental treatment that is not covered by insurance but documents it as a covered treatment.

Oftentimes, this type of fraud is rationalized by the doctors, explaining that they want to help their patients in any way they can, and treatments not covered by insurance are inaccessible due to cost.

3. Misrepresenting Dates of Service

A simple detail like how many visits the patient made to the office can be part of a healthcare fraud scheme.
If the individual went to the office one day and received treatment, that would be considered one office visit. However, healthcare providers make more money when the patient has multiple office visits. For this reason, the doctor may claim that the patient came in for an evaluation one day and treatment the next.

4. Waiving Copayments or Deductibles

Medical care is expensive, and most patients would have no problem with their copayment being waived. However, healthcare providers are not authorized to do this. When they waive the fee, they often add other expenses onto the insurance claim to make up the profit difference.

5. Prescription Drug Fraud

This type of fraud is commonly committed by both the patient and the healthcare provider.
Prescription drug abuse is a serious problem. Some patients will go to multiple doctors to get multiple prescriptions while doctors are unaware that their patients are doing this. The patients may then get the drugs and sell them or keep them all for their personal addiction.

When doctors commit prescription drug fraud, they write prescriptions for unnecessary drugs for patients. They may also steal drugs for themselves but write the cost into their patients’ claims. Another method is prescribing more than the required amount of a drug to a patient, then keeping the excess for themselves.

Miami Criminal Defense

According to the NCSL, healthcare fraud costs insurance companies upwards of $70 billion a year. Because of this, healthcare fraud is aggressively prosecuted. If you are a healthcare professional facing fraud charges, you are at risk of losing your career and license to practice. It is crucial that you immediately contact legal representation to help you fight your charges.

Hager & Schwartz, P.A. have extensive experience with healthcare fraud cases. Give us a call today at (305) 330-1360 to get started building your defense.