Falsifying diagnoses and claims
It’s alarming that somebody might impersonate a medical persona and charge you for treatment, but it does happen. The fraud schemes involving fake practitioners and identify theft totaled almost 30 percent of provider fraud cases last year.
An investigation by Medicare Strike Force Unit unraveled a $11 million fraud scheme involving unlicensed physicians providing medical services. The medical forms, however, were signed by licensed physicians, as if they had been the ones completing the services. In other fraud schemes, one physician falsified Medicare claims amounting to $2.4 million and succeed in obtaining around $1.2 million while an unlicensed nurse in the Oregon area committed identity theft to claim more than $20 million in Medicare reimbursements.
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Taking illegal kickbacks or referrals
Unfortunately, corruption is widely spread in all sectors and the healthcare sector makes no exception. Pursuant to the False Claims Act, it is against the law for providers to receive kickbacks or be involved in any bribery acts in return for referrals. According to the Department of Justice, around 20 percent of last year’s fraud cases involved providers who boosted their profit with the help of kickbacks.
According to HHS-OIG, the largest inspector general’s office in the Federal Government, providers often offer financial incentives to medical companies in exchange for the personal information of Medicare beneficiaries. One such provider managed to “swindle” around $3.2 million from Medicare through illegal referrals. At times, instead of directly giving money, the financial “incentives” are disguised in the form of discounts on facility rentals, luxury vacations or gifts.
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