Health 2.0 Conference Spotlights Healthcare Scams

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You might have experienced situations where you get a call from a supposed medical officer asking you about your medical care number to issue a new card, another message offering you tremendous discounts on healthcare insurance, and the offer ends within the next two hours, so you have to make a payment quickly, or might have received a mail from your past insurances asking for renewal. All these healthcare messages that appear to be true can be the trick of a healthcare scammer to get your SSN, financial or personal information, or insurance number. Scams and abuses are as common in healthcare as in other industries.

With passing times, healthcare scams have also upgraded their tactics or strategies of tricking people into their traps. Many healthcare professionals agreed with this statement at the Health 2.0 Conference. Many shared how these scammers are using the names and designation of these genuine healthcare providers in conducting their healthcare scams. Considering the growth in these healthcare scams, let’s discuss the various types of healthcare scams and abuses that are impacting people’s trust in the healthcare industry. Before diving into the categories of healthcare scams and abuse, let’s also learn a little about them.

Healthcare Scams & Abuses, Highlights Health 2.0 Conference

Healthcare Scams refer to the deliberate manipulation of services to gain unjustified refunds, whereas healthcare abuses refer to inconsistent practices along with accepted medical or fiscal methods. These practices can be categorized into four different types:

Health Insurance and Medical Billing Scams

These healthcare scams are related to insurance and medical billing scams in which the healthcare provider or the individual betrays an insurer in order to receive a more significant rebate. Scammers conduct these medical billing scams in a variety of ways. Some of the most common ways highlighted at USA healthcare conferences are upcoding, unbundling, billing for services that were not provided, false diagnoses to justify medical treatment, and receiving kickbacks for patient referrals.

  • Huge Medical Discount Scams

Some US healthcare conferences shared how many insurance scammers allure people with insurance packages that cover almost everything. One has to pay monthly fees to them, and medical care will cover all their expenses in case of an emergency. Although some insurances offer real discounts, many people have reported scams in medical insurance. Even though they paid monthly charges, at the time of crisis, medical insurance brought some hidden claims, according to which they can’t get a refund. While signing up for insurance, read all the terms and conditions carefully, and if the offer appears too good to believe, don’t take it at all.

  • Questionable Claims

Insurance scammers often call an individual a government official or insurance company. Neither government nor the insurance companies will contact you through a phone call to get your personal details. If you receive any calls that are interested in your personal and banking details, it’s a scam! Don’t share anything; instead, report to the officials. Insurance scammers sometimes send an official-looking email to appear legitimate to the person, in return asking for money or personal information. Verification is the first step, and contact your insurance company before sending the details directly. Many healthcare insurance companies highlighted at Health 2.0 Conference that scammers usually portray their policies as licensed under the Employee Retirement Income Security Act (ERISA). In reality, ERISA is a federal organization, and state organizations do licensing procedures.

  • Unexpected Fee Submissions

Other scammers trick the people by asking them for fees to provide them with the best insurance policies, which is again illegitimate, as no one can charge an individual for introducing them to government policies. Calling people and asking them to submit a fee within two hours to continue their policy is another trick of scammers. Research well before sending any fees to these insurance scammers, suggests insurers at various US healthcare conferences.    

  • Upcoding Scams

These medical billing scams involve sending a bill to medicare in an exaggerated form, i.e., with costly services that were not even given to the patient. It may include showing more hours, associated people, equipment used, billing for procedures that the person doesn’t need, or including a process that didn’t happen. Healthcare providers do upcoding, and professionals to gain more profits from the consumers.

Unbundling Scams

Unbundling scams include billing a single procedure into different steps using different billing codes, even though they could be placed together under the same code. The refund of separate bills would be more than the single billing, which is why people indulge in such practices.

  • Billing For Unprovided Services

Another medical billing scam is when healthcare providers submit bills for services not given to the patient. This billing of unprovided services violates the False Claims Act, and the government doesn’t pay for them at all.

Home Health Care Scam

Home healthcare scams are where home health agencies bill insurers, government benefit programs, or homebound patients asking for unnecessary services or services that were never delivered. It can also fall under medicare scams when a homebound patient receives home care as part of a benefits program and scams if claims are submitted that are not compliant with government program requirements.

Various healthcare professionals at USA healthcare conferences revealed how many healthcare scams take place, making it difficult to determine whether the claims are valid. Let’s discuss a few of the most common home healthcare scams.

  • Elderly Abuse

Many times, elderly people leave the hospital and opt for home care believing the person in charge will take care of them. But many healthcare providers at Health 2.0 Conference shared how they were in trouble because some homecare attendants didn’t take good care of the patient, which eventually led to the patient’s death. Even though the attendants were fined and jailed, the reputation of the home care providers was affected as people found it difficult to trust them with their family members.

  • Company Compliance & Regulatory Scam

Some fake healthcare providers appointed their known homeless people as in-house staff members without caring whether they were medically trained or not. It was done to provide homes to these homeless people at the cost of the patients who actually needed medical assistance. Recruiters were fined for conducting such a scam. Such healthcare scams affect patients’ lives, which is why serious charges are placed against these fake homecare attendants and associated companies.

  • Background Check Scam

In this type of scam, home care companies falsify or do not conduct criminal background checks for home health care attendants. As each state has its set of rules and regulations around background checks for home healthcare workers, medicare does need background checks for its federal health insurance program. But, many agencies forget that private health insurance companies or families paying for direct home health care services are not subject to these rules. Not getting a background check is a home care scam for these privately managed care companies.

Medicare and Medicaid Scam

Medicare and Medicaid scam refers to illegal practices intending to get unfairly high refunds from government-funded healthcare programs. Common examples of Medicare or Medicaid scams are billing for services that weren’t provided, performing unnecessary tests, and receiving benefits when you’re not eligible.

Common Examples Of Medicare & Medicaid Scams

  • When billing is done for the services that weren’t provided, either in the form of phantom billing or upcoding.
  • Performing irrelevant tests or giving unnecessary referrals is known as ping-ponging.
  • Extra charging for services that were supposed to be charged at a package rate, known as unbundling.
  • Treating patients poorly or abusing them for money or personal information is another type of scam.
  • Giving extra benefits to the patients even when they are not eligible for them by misinterpreting their reporting assets and income. By manipulating this financial information, they make the person eligible for these benefits.
  • Unlawful filing of claims for refunds even if the claimant is not qualified, again by manipulating the truthful information.
  • Indulging in identity theft to get the added services by pretending to be someone suitable for those services.

Drug Fraud and Abuse

The most common types of drug fraud and abuse are counterfeit drug fraud, drug pricing fraud, and drug diversion abuse.

  • Counterfeit drug fraud is when a physician willingly pushes stolen, expired, altered, or fake prescription drugs.
  • Drug pricing fraud is when a physician prescribes unneeded medication to a patient to profit from the sale.
  • Drug diversion abuse is when a healthcare worker does not administer a patient’s medication but keeps it for personal profit.

Key Takeaways

As we have discussed, various healthcare scams are a matter of concern for the healthcare industry as they are affecting their reputation and trust in the market. These healthcare professionals are sharing their suggestions at various USA healthcare conferences to create awareness among people and guide them to identify and prevent themselves from these growing scams. One can attend Health 2.0 Conference in USA or Dubai to witness the global healthcare experts and learn about the ways to be considered while investing in life care insurance and any medical policies.

 

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