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What Are Examples Of Health Insurance Fraud?

Watch this video to learn more about the examples of health insurance fraud and what to do about different types of health insurance fraud.


Learn More:

Health Insurance Fraud Or Healthcare Fraud

What Is Medical Malpractice?

The Consequences Of Medical Malpractice


Video Transcript

0:00 Intro
0:37 Types Of Health Insurance Fraud

Well, for instance, if you have a service that was allegedly provided but not actually provided yet billed to Medicare/Medicaid/Tricare federal employee’s benefit program, that’s just clearly direct healthcare fraud.

0:37 Types Of Health Insurance Fraud

The more common issues with healthcare fraud are a violation of the Medicare conditions of participation or any kickback is very common where an individual is paid an amount of money or receives remuneration of some kind in consideration of a referral of a Medicare/Medicaid/Tricare patient to healthcare rendered for treatment. That’s a very common scenario. Then again, self-referral is another common entity. 

You can also have the billing in the case of oncology patients. Many times, chemotherapy is provided free of charge to cancer patients by foundations and other charitable entities. Providers wrongfully bill for that chemotherapy, when in reality, they’re not entitled to do that unless they actually purchase the chemotherapy. 

Those cases are actually somewhat common too among oncologists. They violate the prescription drug marketing act. That is, you cannot charge for drugs you don’t pay for.

Those are some of the more common examples.

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