Healthcare fraud is a federal crime under most criminal codes, consisting of intentional deceit for the purpose of illicit gains. Healthcare abuse is similar activity or behavior where knowing intent to obtain an unlawful gain cannot be established. Some examples of healthcare fraud and abuse include:
Healthcare fraud is a federal crime under most criminal codes, consisting of intentional deceit for the purpose of illicit gains. Healthcare abuse is similar activity or behavior where knowing intent to obtain an unlawful gain cannot be established. Some examples of healthcare fraud and abuse include:
- Phantom claims for services or supplies that were never provided.
- Using someone else’s medical insurance information to obtain services or supplies.
- Falsifying signatures or medical records to support misrepresented services or supplies.
- Unbundling services from a group to unlawfully increase medical payment.
- Misrepresenting the location where services or supplies are provided.
- Rendering medical care without a license.
- Duplicate claim submissions.