TOP TEN SCHEMES EXPLAINED

The ten most common types of federal health care fraud schemes and a short explanation of how they operate are listed below. This is not a complete list, and they are in no particular order. This list of 10 includes:

1. Billing for services not rendered: This involves a medical provider or facility submitting claim forms to federally funded government health care plans or insurance companies for medical services that were not actually provided. These are usually fairly easy for federal investigators to spot through billing documents. This scheme is a favorite of federal prosecutors as they are easy schemes for juries to follow and understand. 
2. Billing for services that are not covered: This involves a medical provider or facility providing a form of care or treatment that is not approved by federal health care plans or health insurance companies. When the medical provider goes to bill for the care, they bill federal health care plans or health insurance companies for something else that is on the approved list. This commonly occurs when there is some sort of experimental treatment that the medical provider is trying to sell.
3. Waiving deductibles or co-pays: Most federally funded government health care plans and health insurance companies don’t allow medical facilities to waive the deductibles or co-pays of their patients. This often leads to other false claims to make up for the money spent to cover a patient’s deductible or co-pay. 
4. Corruption: This involves schemes for referral fees or kickbacks that are not allowed by federal law. Medical providers are not allowed to pay or receive kickbacks for the referral of patients treated under a government health care plan. These schemes lead to abuse as referrals are made for services that aren’t needed.
5. False or unnecessary prescriptions: This involves medical facilities or doctors writing prescriptions for people who don’t need them. This is most commonly found in the abuse of painkillers, where doctors are found to create “pill mills” which result in an excessive amount of prescription level painkillers on the black market.
6. Incorrect reporting of procedures or medical diagnoses: Incorrect reporting of procedures involves a medical provider knowingly recording their patient’s care in order to make the most money. The incorrect reporting of medical diagnoses involves a medical provider knowingly giving patients wrong diagnoses which end up requiring unnecessary medical care and testing, leading to more money for the medical provider.
7. Misrepresenting the service provider: This involves a medical provider billing for services at the rate of a physician, but actually provided by lesser-qualified people. Many times, the patient doesn’t even know this is going on and believes the person administering care is actually a physician.
8. Misrepresenting the dates of medical service: This involves a medical provider billing for multiple office visits in order to maximize profits regardless if the patient actually made multiple visits. Each separate visit is usually its own billable service, which leads to medical providers illegally trying to inflate the services rendered.
9. Misrepresenting the location of medical service: This involves a medical provider falsely claiming that patients were given medical care at certain locations in order to illegally maximize profit. If a patient comes in for care, then a medical provider makes more money as opposed to a patient being sent home with medicine to take themselves for instance.
10. Overuse of medical services: This involves billing for medical services that aren’t necessary. This is often a scheme by medical providers that is used on hypochondriac patients who will continue to receive care as long as they are able.



It is normal to have questions about the various schemes listed above. If you have any questions about the schemes listed above or are being investigated for any of the above listed health care fraud schemes, then it is important to speak to an experienced federal health care fraud attorney immediately.