Is Medical Billing Fraud a Felony?

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In the United States, crimes are broken down into different categories based upon how serious they are and what the mandated penalties are for those crimes. The different classifications are infractions or violations, misdemeanors, and felonies, with felonies being the most serious of the three. Though most people think that a felony has to involve a person causing physical harm, but that is not the case. Felonies include white collar crime and fraudulent activities.

Among the various nonviolent felonies that are committed in the United States, health care fraud is one of the most common – in fact, it has been estimated that ten percent of all monies spent on healthcare is lost to fraud. There are many different types of health care fraud, and one of the most common is medical billing fraud, which is committed by providers who issue bills for services that have not been provided, or who bill inappropriately in some other way in order to get more money than they deserve. If you work for a company that is committing medical billing fraud, you can file a whistleblower complaint notifying the government of this illegal activity. Successful whistleblower complaints not only lead to stopping fraud, but can also yield significant rewards for those who call attention to the crime by reporting it. If you suspect that medical billing fraud is happening, it is important that you know the appropriate steps to take in order to make sure that your complaint is filed correctly. Contact the attorneys at Bochetto & Lentz to learn more about this complex process, and how we can help.

Those who commit medical billing fraud do so in a number of different ways. These include:

  • Upcoding – Submitting a bill to an insurance company using the incorrect billing code in order to get paid more money.
  • Phantom Billing – Submitting a bill for services that are not actually performed. Not only does this cost the insurance company enormous amounts of money, but can also impact the client’s healthcare coverage in the future.
  • Inflated Bills – This is frequently done in conjunction with a hospital stay, when hospitals overbill for services or supplies, double bill for stays that are longer than what the patient actually used, or for services or supplies that were never actually provided.
  • Unbundling – When specific procedures involve multiple processes or supplies, hospitals are supposed to bundle them into packages that cost less. Unbundling bills for each individual process or supply separately in order to bill at a higher rate.
  • Self Referrals – Physicians are specifically forbidden to order tests from a facility or professional in a way that leads to them receiving compensation in return.

Fraudulent practices in medical billing cost the American consumer millions every year and contribute to rising medical costs and insurance costs. If you know of medical billing fraud that is going on, you may be able to stop it and get compensation for doing so. Contact the Philadelphia law firm of Bochetto & Lentz to learn more.

 

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