Types of Medical Billing Fraud and Abuse

<div dir="ltr" style="text-align: justify;" trbidi="on">Medical billing and Fraud account for an approximate $80 billion a year in health costs in the US causing a detrimental effect onto the whole system at large. <br /> <br /> The result has seen an upsurge of costs for Medical cover over the years' that has essentially made it difficult for many people to acquire sustainable medical cover that they can afford. Medical providers have been known to make extraneous mistakes when coding patients that has resulted in many patients being overcharged for services rendered. <br /> <br /> Fraud and abuse as related to the medical industry have two different definitions. Fraud on its part is an intentional deception of facts that lead to unauthorized payment while abuse on its part defines actions that are improper inappropriate outside the acceptable standards of professional conduct.<br /> <br /> <div style="text-align:center;"><a href="http://www.medicalbillingcodings.org/2013/12/types-of-medical-billing-fraud-and-abuse.html"><img alt="Types of Medical Billing Fraud and Abuse" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPEqdzjcjue6FHSwa0eGkwsuXTtuMAxncs4rcPtNnNNZ5ygjR5wqZmY_QvXDPj9DcTFlcNrNBgji6IhYzgOWTDoMIo1MUApKD6FBKwXsjVozmeVxwhJjrzqJsmePf5gK-4qffWWueltAo/s1600/healthcare5.jpg" /></a></div><br /> Fraud may include submitting claims for services that have not been rendered or falsifying the claims for the sole purpose of personal enrichment. Abuse on its part may include improper billing practices or failure to maintain accurate records for the purpose of billing. Fraud and abuse when combined can result on harm to people affected by them. <br /> <br /> Medic billing Fraud and Abuse has become a national calamity with investigators and prosecutors nowadays more aggressive in investigating and prosecuting any form of fraudulent activities.<br /> <br /> <h2>Medical Billing Frauds and Abuse Types</h2>The following are some of the most common and vibrant Medical Billing Fraud and Abuse problems greatly affecting the health care industry.<br /> <br /> <h3>Healthcare Fraud Schemes</h3>Healthcare fraud is a type of white-collar crime that involves the filing of dishonest health care claims in order to turn a profit. <br /> <br /> Fraudulent healthcare schemes come in many forms. Practitioner schemes include: individuals obtaining subsidized or fully-covered prescription pills that are actually unneeded and then selling them on the black market for a profit; billing by practitioners for care that they never rendered; filing duplicate claims for the same service rendered; altering the dates, description of services, or identities of members or providers; billing for a non-covered service as a covered service; modifying medical records; intentional incorrect reporting of diagnoses or procedures to maximize payment; use of unlicensed staff; accepting or giving kickbacks for member referrals; waiving member co-pays; and prescribing additional or unnecessary treatment. <br /> <br /> Members can commit health care fraud by providing false information when applying for programs or services, forging or selling prescription drugs, using transportation benefits for non-medical related purposes, and loaning or using another’s insurance card. The following annual statistics are reported by the news media, by type of Healthcare fraud in United States:<br /> <br /> <div style="text-align:center;"><a href="http://www.medicalbillingcodings.org/2013/12/types-of-medical-billing-fraud-and-abuse.html"><img alt="Healthcare Fraud Schemes" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEig1mq4qcAb089NhrpM-lBSfawpw77jPZ2TTW0m7W9cvKso5Hg5Dltk8SqMEzNOhwWCImLL7ODmROh7soLpZo54IRzLTwwIbBS9MXb4xGjKoh3_dNMMMr_K7c19RhigCaNccr1I1zatujWl/s1600/medical-billing-insurance-frauds-types.jpg" /></a></div><br /> <h3>Medicare & Medicaid Insurance Frauds</h3>Medicare Fraud Continues to Skyrocket despite of Anti-Fraud Laws and crackdowns. Medicare strike force under the Department of Justices and the Department of Health and Human Services uncovered and arrested more than 1480 suspects and for more than $4.8 billion in alleged healthcare fraud in Chicago, Miami, Dallas, Houston, Los Angles and Brooklyn.<br /> <br /> Medical frauds in Medicare and Medicaid involves fraudulent prescriptions, bills submitted for inflated rates of service, for service that was never provided, fake medical supplies or billing against dead patients.<br /> <br /> <div style="text-align:center;"><a href="http://www.medicalbillingcodings.org/2013/12/types-of-medical-billing-fraud-and-abuse.html"><img alt="Types of Medicare & Medicaid Insurance Frauds" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNdGHF2tDBJ5B1CTLpMrqFv-V3iji_W4-sgyYgCfn-5D8qyzsjbfT_mrSco34L1nWGx0oZ4HEUYrHfB1r7Nlc2FSi81FhojTG7M_XJ90MVMWF3pVV9uDuvjyaqfyfDgtBuW7j7Gp6saTO6/s500/medicare+fraud.jpg" /></a></div><br /> <h3>Upcoding</h3>This is one of the most common fraudulent issues that involves health care providers submitting claims for a service that is more severe than the actual service that was rendered to a patient. <br /> <br /> This can involve reporting a fractured knee while one was only bruised. Unnecessary treatment can also result in fraud as a provider might perform unnecessary tests in order to carry out billing.<br /> <br /> <h3>Over Billing</h3>Inflated hospitals bills are the other common medical billing fraud that patient s have constantly reported especially on gross overcharges for procedures performed. <br /> <br /> There have been scenarios where patients have been overcharged on equipment’s offered. Inflated hospital bills also arise from billing for services or supplies that were not provided.<br /> <br /> Length of stay is the other common front where issues with medical billing have been known to arise. Patients are supposed to be billed for the exact days they were in the providers facilities, at times it happens a medical provider adds the number of days a patient might have stayed in the facility for the purpose of personal enrichment.<br /> <br /> <h3>Phantom Billing</h3>Medical examinations are normally carried on patients depending on the conditions that one is experiencing. Some Health care providers have been known to generate automatically detailed patients observation profile by copying from other patients records that might have undergone the same tests using an <a href="http://www.medicalbillingcodings.org/search/label/EHR">EHR systems</a>. <br /> <br /> This most of the time results in patients being overcharged for tests that were not carried out in the first place. Phantom billing is the other error that can occur in this case that can result in billing for services never performed.<br /> <br /> <h3>Service Fragmentation</h3>Service Fragmentation involves the billing of multiple procedures separately. This essentially results in double billing as the same services could be billed as one. Service fragmentation can also entail repeat billing where one service is billed twice. <br /> <br /> If you or your organization have been a victom of any of obove types of Medical Billing Frads, don't wait and contact a Medical Billing Advocate. You can learn How <a href="http://www.medicalbillingcodings.org/2013/12/how-MedicalBilling-Advocates-legal-help-issues.html">Medical Billing Advocates can help</a> in Legal Issues.<br /> </div>

Types of Medical Billing Fraud and Abuse

Medical billing and Fraud account for an approximate $80 billion a year in health costs in the US causing a detrimental effect onto the whole system at large. The result has seen an upsurge of costs …

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How Medical Billing Advocates can help in Legal Issues

<div dir="ltr" style="text-align: justify;" trbidi="on">A Medical billing advocate can be helpful in issues that need legal advice, consultation and advocacy for the resolution.<br /> <br /> Medical billing advocates are an integral part of the health industry as their job entails ensuring that all medical claims are paid on time and in the right amount. A medical billing advocate can help a patient in ensuring that he or she is not overcharged for the services rendered while also ensuring that refunds are given out when required to reduce the bills.<br /> <br /> A medical billing advocate is what anyone who feels intimidated by the medical insurance language needs as he or she will have the utmost skills to maneuver any sideshows or derailments that the companies are known to present. Medical billing advocates are normally trained to respond to inscrutable stack of bills that patients may be dealing with from doctors’ offices and insurance companies. It is not a secret that 8 out of 10 medical bills are always known to contain errors that Medical billing advocates can detect instantly.<br /> <br /> <div style="text-align:center;"><a href="http://www.medicalbillingcodings.org/2013/12/how-MedicalBilling-Advocates-legal-help-issues.html"><img alt="How Medical Billing Advocates can help in Legal Issues" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQSthCN78jFbdtVM5WPm4iLUGA4JaLxrrC4H0Nhyphenhyphenrpe5iKEM7hkwT0CNoAXqGUiptwyp4E6iqZtqQXIILwb0aNevHDN55gWTdvvpLrZDWiwboNsBVIn7edtJkqfUQtu7MOYXpAVM6Ribw/s1600/Medical-Billing-Advocates-can-help-Legal-Issues.jpg" /></a></div><br /> <h2>Medical Billing Advocates for Frauds and Legal Issues</h2>Fictions and frauds are most of the time known to arise from bills charged by health care institution that might have rendered some medical services. It is the responsibility of a medical billing advocate to detect this frauds and errors so that one is only required to pay the required amount for the rendered services. <br /> <br /> <h3>Legal Consultation and Advice</h3>Medical billing advocates play an important role in giving the much needed assistance in understanding the medical bills that at times might be quite strenuous to understand. They play the position of a translator in ensuring you are able to understand the bills in your most suited language.<br /> <br /> <h3>Legal Issues with Insurance Company</h3>If you have been intimidated with the constant nagging of the insurance company, then you need to seek the help of an experienced medical billing advocate as he/she will be in apposition to detect the contentious issues that you might be having with your insurance company. <br /> <br /> There may be times when your insurance company is wrongly with-holding claims or coverage for critical treatment. Paying a medical billing advocate a visit will be the first step in airing your case out as he or she will be able to arrange a sit in with the insurance company to ensure that all your rights in terms of claims and coverage are respected. <br /> <br /> <h3>Overcharge and Policy Violation Issues</h3>A medical billing advocate will always scour your bills to detect any signs of overcharges and no billable services as well as duplicate charges that have violated the ethics of medical billing and coding. The advocate will also be at hand to review your insurance statements to ensure that your policy pays for what it covers.<br /> <br /> Whether insured or not it is always advisable to hire the services of a professional medical billing advocate or medical billing legal consultant firm to ensure you are properly billed by a health provider. Clerical errors are some of the errors common with many claims that an advocate will always be at hand to detect.<br /> <br /> Below are some of the errors that any medical billing advocate will always be at hand to detect and ensure they are corrected.<br /> <ol><li><b>Duplicate Billing</b>: arises when you are charged twice for the same service, drugs or supplies.<br /> <br /> </li> <li><b>Typos</b>: arises when incorrect amounts are entered into your bills or incorrect billing codes.<br /> <br /> </li> <li><b>Canceled Work</b>: being charged for a test that your doctor might have ordered but later canceled.<br /> <br /> </li> <li><b>Upcoding</b>: this arises due to inflation of charges especially in scenarios where a doctor prescribes a generic drug but later bills a more costly drug.<br /> <br /> </li> <li><b>Inflated Operation Room Fees</b>: being charged more than what the anesthesiologist records.</li> </ol></div>

How Medical Billing Advocates can help in Legal Issues

A Medical billing advocate can be helpful in issues that need legal advice, consultation and advocacy for the resolution. Medical billing advocates are an integral part of the health industry as thei…

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