Have you been a victim of health care fraud? If you have, you may be entitled to compensation for the monetary damages you have suffered.
However, in nearly all instances, proving health care fraud is not easy. In order to do so, you will need the expertise and representation of an experienced personal injury attorney. The wise thing to do is to contact a personal injury attorney and have your case evaluated at no cost or obligation to you.
Health care fraud is defined as being, “The knowing and willful executing, or attempt to execute, a scheme or deceit to defraud a health care insurance or benefit program, or to obtain by fraudulent means any benefit or payment from the program.” It is a type of fraud that is perpetrated by an individual, insurance company or medical provider that uses the health care system in a deceitful manner for the purpose of profiting from it.
When you are the victim of health care fraud that is carried out by an individual, medical provider or insurance company, it involves the deliberate billing for a service that was never provided or for a service that has a higher reimbursement than the service produced. More specifically, health care fraud involves an intentional act of deceit or an intentional deception or misrepresentation in order to gain a greater reimbursement.
There are several ways in which health care fraud may be committed. Some of these include:
Billing for services not rendered or goods not provided
Misrepresenting procedures or diagnoses in order to maximize payments
Misrepresentation of the service being provided
Billing for services that are not medically necessary
Falsifying certificates of medical necessity
Falsifying medical records or plans of treatment to justify payments
Submitting duplicate claims for the same service
“Upcoding” – charging for a more complex or expensive service than was actually provided.
There are some things you can do to guard against and help prevent and fight health care fraud. Some of these are:
Counting your pills every time you get a prescription
Protecting your insurance card and personal information at all times
Reporting health care fraud as soon as possible
Researching your health care providers with your state’s medical boards
Reviewing your explanation of benefits to make sure of things like types of services reported, dates of service and names of providers.
In addition, you should seek verification when a health care provider tells you:
The more tests given, the “cheaper” they are
Certain equipment or a test is “free” but your insurance number is required for “record purposes”
Your insurance company will pay for the equipment provided or the services rendered – if an inaccurate description or incorrect diagnosis is communicated to it
Your insurance company can be convinced to pay for the equipment provided or the services rendered.
Again, if you have been a victim of health care fraud, you may be entitled to compensation for your monetary damages. The wise thing to do is to contact a personal injury attorney and have your case evaluated at no cost or obligation to you.
Article written by James Shugart
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