Examples of Health Insurance Fraud:
- Doctors billing insurers for a more costly service than the one performed (also called "upcoding")
- Providing services such as tests, surgeries or other procedures that are not medically necessary to get additional payment
- Billing for services not actually rendered (often using genuine patient names to fabricate entire claims)
- Billing each stage in a procedure as if it were a separate procedure (known as "unbundling")
- Accepting kickbacks for referrals
- Organized criminals setting up a phony clinic solely to generate fraudulent claims
- Patients forging receipts to get unwarranted reimbursement from an insurance company
- Patients embellishing, adding to or just plain lying about services received
- Patients who ask their doctors to falsify a report to an insurer to cover a non-covered procedure
- Patients who ask a doctor to waive their copayments
Thanks to:
http://www.helpstopfraud.org
