Every year, health insurance premiums get more expensive. The cost of some prescription drugs is in the hundreds of dollars. Worse, even with insurance a trip to the doctor or dentist can end up resulting in you getting billed thousands. Why is healthcare so expensive?
Part of the exorbitant cost of healthcare comes from rampant fraud throughout the healthcare system itself. Every year, healthcare fraud costs Americans tens of billions of dollars, with numbers reaching into the hundreds of billions. Yes, that is billions with a “B.”
This fraud comes in many forms. With so much money pouring through the industry, it can be hard to keep up with every instance of fraud. We do know, however, that healthcare fraud is not just committed by greedy healthcare executives who want to mess with the little guys. Individuals are frequently charged with healthcare fraud.
Different Healthcare Fraud Schemes to Be Aware Of
Some common healthcare fraud schemes include:
Misrepresentation. In some situations, slight details could significantly alter your ability to get reimbursement for healthcare services, so individuals and healthcare providers sometimes fudge the facts.
For example, patients who seek medical treatment within 14 days of a car accident will receive compensation for their services. After the 14 days has passed, the individual will have to pay out-of-pocket. The difference of one or two days can make a big difference.
If you give the wrong date to healthcare providers in an attempt to receive compensation, this is actually a form of fraud called misrepresentation. Misrepresentation of the location or provider of a service is also common.
Billing for Services Not Rendered. Or maybe the service didn’t happen at all. Healthcare providers sometimes submit a claim for false patients or false services in order to cash a check for themselves.
Overutilization of Services. There is a fine line between which services qualify for compensation and which do not. Remember the episode of Seinfeld where Jerry, George, and Elaine all used fake notes from a dentist friend to get free massages? Things did not end well for the dentist.
When an insurance company pays for unnecessary treatments, taxpayers are the ones who ultimately lose. If you are not sure what treatments qualify for reimbursement, check with your insurance provider. You may have to adjust your plan based on your medical needs.
“Doctor Shopping” For Painkillers or Prescription Drugs. Here’s a shocking fact: a majority of drug overdoses involve prescription drugs. The people hooked on painkillers and other prescription drugs will do anything they can to feed their addiction.
Many addicts will go “doctor shopping,” or visit multiple doctors in order to get multiple prescriptions for specific drugs. The doctors usually don’t know that the patient already has a prescription to the drugs in question.
Additional charges can be pressed if the drugs are distributed to other people – prescription drug fraud is an extremely serious charge to have against you.
Corruption or Bribery. More than one party can be involved in healthcare fraud schemes. In some cases, a patient and a healthcare provider will help each other out in order to use the system incorrectly. This form of bribery is often referred to as a “kickback.” A classic example of these kickbacks is a healthcare provider who exchanges referrals for a highly discounted price on office space.
Due to the cost of healthcare fraud to the industry as a whole, as well as to the average American, this is something that prosecutors and lawmakers tend to take very seriously. Fighting these charges requires a serious defense. Get a serious Florida fraud lawyer to represent you through the criminal process.
About the Author:
Attorney David W. Olson is the founder of the Law Offices of David W. Olson in West Palm Beach. He has been practicing criminal law and successfully representing clients throughout the State of Florida for over 30 years. Throughout his legal career, Mr. Olson has been honored numerous times for both his dedication and excellence in criminal law. He proudly holds the Martindale-Hubbell AV Rating, as well as being recognized as a Top 100 Trial Lawyer (2013), in the Nation’s Top One Percent of attorneys (2015), and as a 10 Best Member of the American Institute of Criminal Law Attorneys (2015). He has even received commendations from members of congress and other public officials for the fantastic work that he’s done. Mr. Olson graduated from the University of Florida’s Fredric G. Levin College of Law in 1981 and has been a member of the Florida Bar since 1983.