Americans rely on doctors and nurses to look after their physical, emotional, and mental health. Sadly, some unethical medical providers abuse their patients’ trust by committing medical billing fraud, which can include billing for services a patient never received, inflated and duplicate billing, and misrepresenting professional credentials to receive higher insurance payouts.
The National Healthcare Anti-Fraud Association (NHCAA) estimates tens of billions of dollars are lost every year to healthcare fraud in the United States. Schemes involving fraudulent medical billing constitute a significant proportion of those losses.
Medical billing fraud is a serious crime. In June 2018, the United States Department of Justice charged 165 medical professionals with participating in billing fraud schemes that caused $2 billion in losses. Medical billing fraud takes a heavy toll on consumers through higher health insurance premiums.
Still, the direct victims of medical billing fraud can face consequences that are far worse:
When Floridians fall victim to medical billing fraud, it can help to have an experienced lawyer by their side. At the Florida Law Group, we have represented victims of medical billing fraud, helping to protect them from the financial, emotional, and even physical fallout of the fraud, and to take action to recover compensation and receive the justice they deserve.
According to The Coalition on Insurance Fraud, dishonest medical professionals commit the majority of medical billing fraud crimes. Although these bad actors only constitute a small fraction of healthcare providers, their duplicity harms the reputation of ethical providers everywhere. They can include:
The Association of Certified Fraud Examiners reports the following common fraudulent medical billing schemes:
Medical providers submit claims to insurance companies or federal health plans for services they never performed. In some cases, such as when patients have been under anesthesia, they may not even suspect these services didn’t happen.
Physicians may charge insurers for procedures not covered by patients’ insurance plans by instead submitting the bill under a different billing code, disguising it as a service the insurer does cover.
Insurers usually consider an office visit or medical procedure as a single, billable item. To earn more, some medical providers submit claims for every step of a procedure, rather than a whole unit. Additionally, they may send bill one office visit for as a series of multiple consultations.
Providers may charge patients for office visits at which the provider or the patient was not physically present. For example, a doctor may give a patient an allergy treatment, then tell them to self-inject the medicine at home. The professional may bill insurers for the at-home treatments, claiming them as office visits.
The provider you visit may not be a licensed, medical doctor. Some doctors’ offices misrepresent their staff members’ credentials.
This fraud is rampant in the psychology field. A practice will hire licensed social workers to perform services reserved for psychiatrists with a medical degree. These professionals are reimbursed at a lower rate by insurers, so they claim the social worker is a doctor. This allows them to charge insurers more.
Some people pretend to be medical professionals to defraud patients and insurers. One prominent case occurred in Florida recently. Malachi A. Love-Robinson, an 18-year-old, posed as a doctor. The young man claimed to be a well-rounded person that used physiological, psychological, and mechanical methods to treat illnesses. Love-Robinson gave medical advice to many patients before he was arrested.
Other practices hire untrained workers to perform medical services.
Most federal health plans and private insurers require patients to pay some out-of-pocket expense like co-payments or deductibles. When fraudster doctors offer to waive a co-payment, it may be because the doctor is charging the insurer for a procedure never performed and does not want the patient to find out.
Some physicians falsely diagnose patients with severe illnesses to charge insurers and patients more money. Serious diagnoses often require more expensive treatments, hospital stays, and more tests. In effect, doctors subject their patients to medical care—and medical bills—they don’t need. Not only is this fraud, it’s can also be very dangerous for patients, particularly if they’re prescribed medicines they do not need that have adverse effects.
People are in poor physical or mental health are especially vulnerable to this form of fraud, because they often lack the capacity to distinguish between accurate and inaccurate medical advice.
Medical billing fraud usually results, at a minimum, in the victim suffering financial losses. In some case, things get much worse, and the victim also suffers physical and emotional damages, such as when they do not receive proper medical care because of the fraud.
In the majority of cases, the medical provider who intentionally engages in a fraud has liability for damages to the victim. Sometimes, in addition to the individual fraudster, the individual’s employer may also bear some of the blame for harm caused to fraud victims, because of having failed to spot, stop, or adequately train staff in preventing the fraud that went on. Others potentially responsible to the victim may include those who did not directly engage in the fraud, but who “looked the other way,” such administrative employees or partners in a medical practice that commits fraud.
Victims of medical billing fraud may be entitled to recover compensation from the fraudsters or others liable for not spotting, stopping, or preventing the fraud for:
Preventing healthcare fraud is essential to reducing healthcare costs, avoiding wrongful charges and credit damage, and falling victim to false diagnoses. The National Health Care Anti-Fraud Association offers these tips to protect yourself from medical billing and related fraud.
When you have fallen victim to a medical billing fraud scheme, you may wonder whether you can even afford an attorney to help you out. We understand that concern. At the Florida Law Group, we offer free initial consultations to discuss whether we can help you recover damages resulting from the fraud. In appropriate cases, we may also agree to represent a client who is the victim of a medical billing fraud on a “contingent fee” basis, in which we do not receive fees unless and until we recover money on our client’s behalf. In those arrangements, we may also consider paying court fees and costs associated with pursuing our client’s rights, if the case warrants it.
If you have concerns about affording a lawyer, please do not let it stop you from scheduling an initial free consultation with us.
Are you the victim of medical billing fraud scheme? The Florida Law Group may be able to help. We’ve fought for the rights of our clients since 1984, and are committed to recovering compensation our clients deserve. Contact us at (813) 463-8880. You may also visit us online.
Get Help Today