A common health care fraud scheme involves billing fake charges to health care programs. This can happen in several ways. A provider may bill a health care program such as Medicare for services the provider did not perform. This type of fraudulent billing may include billing for services that were not provided as described in the payment claim, billing twice for the same service, or billing for a service that was never provided at all.
In January of this year, the administrator and part owner of a hospice in Illinois was charged with enrolling ineligible patients in hospice care, a program reserved for patients who have a life expectancy of six months or less. For one patient, the administrator falsely billed Medicare for over four years of hospice care, totaling nearly $200,000.
A provider could also upcode. Upcoding occurs when a provider bills a health care program for services or equipment in a way that makes the bill appear higher than its true cost. For example, a provider might bill insurance for a costly, comprehensive exam, yet only perform a basic exam; or, he might bill insurance for a more expensive model of medical equipment than the one actually delivered to the patient. In 2000, a Tennessee hospital chain settled with the government for $31 million dollars after being charged with overbilling Medicaid, Medicare and TriCare for treating various illnesses and health conditions.