Healthcare fraud is expanding quickly despite efforts to speed it up. Although laws to combat healthcare fraud have been implemented, the taxpayers may be the most powerful deterrent. You can do several things, as discussed at the top healthcare events in 2022, which will be described later, to help stop healthcare fraud. Let’s first examine precisely what is occurring and why.
Although there are many types of healthcare fraud, dishonest service providers are the most prevalent and expensive. They include anybody who orders or offers medical services, products, or treatments, including physicians, nurses, equipment suppliers, pharmacists, etc. That’s true, the medical professionals we rely on and trust are frequently the perpetrators of this kind of crime. Anyone can become a victim, so you must read and abide by the advice provided below on preventing healthcare fraud.
Unreliable service providers can perpetrate fraud in a variety of ways. Here are a few of the most prevalent unlawful behaviors and fraudulent practices noted by healthcare professionals who shared their opinions at the Health 2.0 Conference:
Typical Forms Of Fraud
Careless actions that contravene best therapeutic procedures divert funds away from therapy and are not always committed with criminal intent are known as waste and abuse. On the other side, fraud is an intentional lie or false statement used to obtain unrequested benefits. Payers need to be aware of several all-too-common forms of healthcare fraud.
● Billing for unprovided services and goods: This widespread type of healthcare fraud is one method that clinicians can dishonestly divert money away from patient care and into their own pockets. Examples include billing for patient appointments that never took place or for medical devices that the doctor did not give.
● Upcoding is the practice of healthcare professionals billing for more complex and expensive goods and services than those delivered. This can occur accidentally, such as when a provider inputs the wrong code but frequently results from deliberate fraud.
● Unbundling is the process of submitting bills fragmentarily to maximize reimbursement for tests or operations that should be invoiced together at a lower cost. It is similar to upcoding. For instance, attempting to maximize a lab’s revenue by charging for each test separately rather than for a panel.
● Giving superfluous treatments: Performing unnecessary procedures on patients against their better judgment to profit financially is probably the most heinous example of healthcare fraud. A large amount of these frauds are not talked about enough. It seldom makes headlines when a surgeon advises knee surgery rather than first considering less intrusive choices like treatment. However, this fraud depletes healthcare budgets and hurts people. At a Vegas health care conference, doctors execute tens of thousands of medically unnecessary procedures each year, which is both a severe breach of trust and a significant source of wasteful expense.
● Doctor shopping is when patients visit many doctors to receive various dosages of restricted substances. Either the patient abuses these medications excessively, or they are unlawfully transferred to others. Opioids killed more than 33,000 people in the US in 2015, the worst year on record. Prescription opioids were involved in over half of all opioid overdose deaths. Dishonest patient behavior and negligent prescribing practices by doctors are somewhat related to the widespread use of prescribed opioids. While some healthcare organizations take precautions to stop patients from going to many doctors, others do not.
● Medical identity theft: The digitization of personal health information has provided the healthcare sector with many advantages that enhance care and boost productivity. It has, however, increased the potential of theft of personal health information. Using someone else’s medical identity to gain supplies, services, or money has become a common fraud.
What You Can Do To Avoid Becoming A Victim Of Medical Fraud
As suggested by experts at the Health 2.0 Conference, you can take many easy steps to avoid becoming a victim and contribute to the overall reduction of healthcare fraud.
● Understand your medical history and make inquiries.
First and foremost, keep track of your medical background. Make sure your medical records accurately reflect your tests and diagnoses by keeping track of them. Keeping a health journal and a written description of your medical care can be pretty helpful. Unfortunately, if inaccurate diagnoses are recorded in your medical history, you can receive subpar care.
Ask questions if your doctor prescribes a test or operation about which you are unsure. Obtain a second opinion if you’re uncertain whether a test or procedure is necessary. Learn about the treatments and tests typically recommended or used for any conditions you may have.
● Examine all bills and statements by opening them.
All invoices and insurance statements should be opened and thoroughly examined for accuracy. If you discover unforeseen expenses, first speak with your provider. Look for any duplicate charges, prices for treatments that your doctor did not order, and charges for services you did not receive. Additionally, confirm that the service dates are accurate. If you stay in the hospital, be sure the dates listed for your stay are correct. Inform your insurance provider of any inaccuracies you find. Help an older relative, parent, or acquaintance study their bills and statements if you have them.
● Understand your coverages
Review your insurance contract, paying particular attention to the benefits description. Be aware of the covered procedures. Make sure you get the procedures for which your insurance will pay. Report anything questionable if it appears.
Before leaving the pharmacy, ensure that your medicines are filled appropriately.
Ensure that you take the appropriate medication and receive the prescribed amount and number of doses.
● Carefully handle identity cards.
Theft of medical identities is widespread. Handle your social security and insurance cards with care, and give them just to your physician or your provider. Like you would your credit cards, keep them safe. Your entire medical history can be jeopardized if they end up in the wrong hands.
● Never accept “free” offers.
Be wary of “free offers,” and don’t take them up. Remember that medicare won’t make you a phone call or come to your home to give you anything. Any free medical services or examinations will likely be part of a scheme. If you accept an offer, fraudsters might proceed and charge your insurance for the complimentary services you get.
● To stop healthcare fraud, providers must take action.
To combat healthcare fraud, healthcare providers must also play a significant role. According to a survey, up to 60% of incorrect claims are unintentionally miscoded or handled incorrectly. To prevent intentional or unintentional fraud, providers must invest in training and education. Everyone on staff, from office workers to doctors and nurses, should know what fraud is and how it happens. They should also be aware of the consequences of healthcare fraud for the healthcare system and the penalties for doing so.
Although various changes have been brought into the healthcare sector to make it better, there is a need to establish specific laws and regulations to prevent fraud along with the ever-increasing pace. As suggested by professionals at events such as the Health 2.0 Conference, patients as well as the medical staff both need to follow some precautions to avoid these frauds and take immediate action if they become a victim. These advancements need to be made carefully in order to assist and protect everyone simultaneously.