In 2011, the FBI estimated that three to ten percent of the government’s total healthcare expenditures were lost to insurance fraud. That may sound like a small amount, but with the government’s total healthcare expenditures at about $2.4 trillion, insurance fraud accounts for as much as $240 billion dollars. A substantial amount of that total was stolen by health care providers falsely charging programs like Medicare for services they never performed, and for equipment they never provided. How does this happen? A common way unscrupulous providers submit false charges is by billing the government for services differently than the way they were described in the bill, or for services that were never provided at all.
A common form of fraudulent billing is charging for services that are not rendered. This fraud is committed when health care providers bill insurance for services that are different than the services actually rendered, or bill for services they did not provide at all. Often times the provider will bill for a service or for medical equipment that is more costly than what he actually provides to the patient.
For example, in June of 2013, four Florida residents were found guilty of defrauding Medicare of nearly $70 million. The defendants ran Hollywood Pavilion, a Miami mental health care hospital, in which the defendants illegally paid over $1 million to patient recruiters to refer Medicare recipients to the hospital for psychiatric treatment. The defendants then billed Medicare for psychiatric services they did not provide to the patients and that the patients were not even qualified to receive. In an effort to conceal the illegal manner in which they recruited the patients, the defendants falsified documents to give the appearance that the patients were actually being treated.
Billing for services not rendered is just one of many ways providers defraud the government. If you have evidence that a health care provider is committing insurance fraud, you should report it to the proper authorities, or consult an attorney about filing a qui tam lawsuit on behalf of the government.
Disclaimer: this post was written on October 1, 2014. Please note that the law may have since changed. Please contact our attorneys to evaluate your claim