Medical Billing Fraud – As Serious As It Sounds

As nursing and health care professionals we at NIH take medical billing fraud seriously, and you should too.

In 2007 Americans spent over $2 trillion on health care; and over 3% of those funds went to medical billing fraud.  Some organizations say the figure may be as high as 10%!

What types of medical fraud is out there:  (a) bill for unprovided services; (b) billing for a higher level of service than the patient received (called “upcoding”); (c) the provision of unnecessary services and procedures; and a host of others from “unbundling” to “balance billing” – whatever name they go by the result is the same; insurance companies are bilked out of money.

In addition to the burden on an overwhelmed tax system and the dangers to our own budgets, fraudulent billing which documents misrepresentations in a patient’s chart may lead to wrong treatment, errors in our Medical Information Bureau records, and even medical identity theft.

In an example of a local cause of medical billing fraud and its consequences; one Miami medical billing company executed a scheme to submit fraudulent claims to Medicare over a seven year period, for reimbursement for durable medical equipment (DME) and related services.  They were indicted for $80 million in false claims .  The claims were allegedly fraudulent in that the equipment had not been ordered by a physician and/or had never been delivered to a Medicare patient.  As a result of the submission of the fraudulent claims, Medicare paid the DME companies approximately $56 million.

Because healthcare fraud is so prevalent and expensive, it is often considered part of the discussion of healthcare reform today in the United States.

Interested in learning more about medical billing? Then our Medical Office Insurance and Billing Certificate Program could be the solution for you!


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