What is a health care provider scheme?

When California health care providers render a service, they usually bill the patient’s insurance company. Typically, the insurance company pays their portion of the expenses and moves on. However, some providers deliberately bill the insurance company for false services. If the insurance company doesn’t catch on the first time, the provider might keep doing it and pocketing the profits.

What are some common healthcare provider schemes?

One of the most common schemes involves charging the insurance company for services that never actually happened. For example, the provider might file a legitimate claim but add several false claims on top of it. They might also file a claim for services that never happened, like surgery or physical therapy. These crimes could go on for months before the insurance company catches on.

Another scheme involves billing the insurance company for services that they don’t cover. Some insurance companies don’t cover new or experimental treatments that might not be effective. Despite this, some health care providers submit a claim anyway. If the insurance company isn’t paying attention, they might approve the claim and put more money in the provider’s pockets.

Others commit fraud by charging the insurance company for a false diagnosis. If they claim that their patient’s condition is more serious than it really is, they could bill the insurance company for more extensive treatments. This could also cause issues for the patient later on if their insurance company thinks they’re suffering from a serious illness.

Is it possible to accidentally commit insurance fraud?

A misplaced bill or erroneously charged service might result in accusations of insurance fraud. Whatever the case, an attorney could defend you against these charges and possibly get the case dismissed.