Spotting Scams: How to Identify and Avoid Healthcare Fraud

Healthcare fraud is undoubtedly a patient’s worst nightmare. Healthcare is every citizen’s basic right, but it doesn’t come without risks. Medical malpractices have become commonplace in recent years, and many patients have lost thousands of dollars through misdiagnosis or even wrongful billing. Medical facilities aren’t exempt from fraud either. Patients can fraudulently use their Medicare features to obtain extra treatment.
If you or a loved one has been a victim, proper representation can help you claim compensation for your losses.
“Medicare and Medicaid billings and reimbursements are packed with regulatory compliance requirements. These issues can be complicated and often involve billing by any provider from physicians to hospitals. Having an attorney who can help you facilitate navigate being accused of Medicare fraud or overpayments, can help you succeed,” says a medicare lawyer at Nicholson & Eastin, LLP, which provides various Medicare reimbursement services.
Here, we’ve listed some common healthcare frauds you should be aware of. Take a look.

Fraudulent Bills
Billing fraud is more common than you think. When the medical facility bills you for services they didn’t perform or bills you more for the services performed, you can say that you’re a victim of billing fraud. When the facility charges you for expensive services but performs cheaper versions, it’s called upcoding. On the other hand, when they bundle a few services together and bill you for it while not performing all of them, it’s called unbundling. Both are common forms of billing fraud and happen almost every day.
As you can understand, billing frauds will cost you thousands of dollars more than those genuine services should, so you should be alert about them from the beginning. Ask for an itemized bill, and don’t accept a consolidated one. Check your bill and scrutinize every item to ensure the medical facility has performed the procedure. If you don’t understand something, speak to the authorities and clear any confusion before paying.

Unnecessary Procedure
In billing fraud, the facility bills you for procedures not performed. But in this type of scam, the facility performs them on you to maximize their earnings. It’s particularly risky because unnecessary procedures can sometimes adversely impact your health.
You are a victim of fraud if you find out that the medical facility prescribed unnecessary tests, surgeries, or procedures unrelated to your condition. To prevent it, speak to your doctor about the tests prescribed and what they intend to find through the test results. If you don’t understand a particular item, you can research online to learn more about it. However, be mindful of self-diagnosis and don’t take any medicine on your own.

Prescription Fraud
Similar to unnecessary procedures, prescription fraud occurs when your doctor prescribes extra or unnecessary medicines unrelated to your condition. Selling more medicine enhances their profits, but it can have a long-term side effect on your body and also create chronic illnesses. This fraud takes place because of commissions that doctors receive from pharmaceutical companies. But it’s avoidable.
Ask your physician to describe each medicine and the reasons for the prescription. Doing a quick online research can also help you identify which medicines are not related to your condition, and you can initiate the conversation with your doctor. However, don’t self-medicate based on internet research alone. Speak to your doctor before making any decision whatsoever.

Misdiagnosis can sometimes happen unintentionally. But when a medical facility gives you a wrong diagnosis of a condition to prolong the treatment duration and boost profits or to manipulate you into taking unnecessary tests and medicines, it’s a fraud. Misdiagnosis can have long-term side effects on your body due to wrong procedures or medicines. It can also drain your pocket because of unnecessary procedures and treatment. At the same time, misdiagnosis can delay your actual treatment. If your condition needs immediate medical attention, misdiagnosis can push you toward more harm.
Patients usually don’t have control over misdiagnosis because they believe what their doctors tell them. But if you take medicines for a week and fail to see any improvement in your condition, speak to your doctor immediately.
If you’re a doctor or own a medical facility, be mindful of misdiagnosis because any harm to the patient will land you in legal trouble and have your license canceled.

Negligence or Malpractice
Negligence is another form of healthcare fraud in which the medical facility can’t provide the treatment needed to treat a patient for a particular condition. It can cause financial loss, or adversely affect the patient’s health. It can also cause them emotional stress.
Poor or substandard treatment is a common way of medical malpractice or negligence. When a medical facility diagnoses a condition poorly, provides insufficient or unrelated tests and procedures, and sells a patient the wrong medicines, they subject the patient to negligence or medical malpractice in every step of the treatment process.
While it’s impossible to identify medical malpractice until the effects start to show, you can stay alert and establish good communication with your doctor to understand what treatment you receive. If you believe that you or a loved one has been a victim of medical malpractice or negligence, stop the treatment immediately. Speak to another doctor to understand where you have been deceived, and take action accordingly to be reimbursed for the wrong treatment.

As a patient, you can always fall victim to healthcare fraud. There are reports of extreme healthcare scams and frauds that have turned hospitals and medical facility owners into millionaires. But they also get punishment for their crimes, and the victims can get reimbursement for their losses. So, speak to an attorney today if you believe you’ve been a victim of healthcare fraud.


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