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Small Mistakes That Are Actually Healthcare Fraud

Healthcare providers are responsible for the health and well-being of their patients. To avoid potential harm or deceit, strict healthcare laws and regulations are in place. One key regulation is the Health Insurance Portability and Accountability Act (HIPAA), which ensures the confidentiality and protection of patient medical records.

However, when healthcare staff are not adequately trained, including regular updates to stay informed about changing laws, it can lead to higher instances of fraud, malpractice, or unethical behavior. Even small mistakes can constitute California healthcare fraud, potentially resulting in significant legal and financial consequences for the provider and facility.

At Fenton Jurkowitz Law Group, our healthcare fraud lawyers offer top-tier legal advice to assist you in identifying and addressing small mistakes that are actually healthcare fraud. Our experienced healthcare fraud attorneys can help you implement proper training and regulatory compliance measures to prevent fraud and protect your practice from legal repercussions. Whether you are dealing with documentation inaccuracies, billing errors, or any other fraudulent or abusive activity, we have the knowledge and experience to guide you through the process.

What Is Healthcare Fraud?

Healthcare fraud occurs when a healthcare provider knowingly obtains or accepts benefits or payments to which they are not entitled. For example, under California’s Insurance Fraud Prevention Act, a doctor who bills an insurance company for services they did not perform is committing healthcare claims fraud.

This illegal activity not only disregards ethical standards but also violates state law, potentially leading to severe penalties, including fines and imprisonment.

Small Mistakes Classified as Healthcare Fraud

Billing an insurance company for services that were not performed is a clear example of committing a healthcare fraud claim. However, there are various forms of healthcare fraud, including smaller mistakes that may be more subtle and difficult to identify as fraud.

Below are common types of fraud in healthcare to watch out for to ensure your employees are adhering to the highest legal standards:

• Double billing. Submitting multiple insurance claims for the same service is an illegal and fraudulent type of billing fraud in healthcare. Double billing can lead to major financial penalties and damage to your health practice’s reputation.
• Phantom billing. Submitting a bill to an insurance company for services that were never actually performed is a serious offense. It not only violates ethical standards but also legal regulations.
• Separating services that should be billed together to increase reimbursement constitutes fraudulent activity. This manipulation can result in overbilling and is subject to legal action.
• Committing fraud involves billing an insurance company for a more expensive service than the patient actually received. This practice inflates healthcare costs and reduces trust in the healthcare system.
• Prescription forgery. Forging or altering prescriptions is illegal and unethical. This primarily disregards ethical standards, as alcohol and drug abuse is detrimentally prevalent in the U.S.

Speak to a Healthcare Fraud Attorney

Fenton Jurkowitz Law Group has a team of seasoned healthcare fraud lawyers who can guide you through instances of fraud, including healthcare billing fraud. We don’t just give legal advice, we also want to help you solve the problem quickly and effectively. We recognize the importance of preserving your reputation, maintaining operational continuity, and complying with healthcare regulations. Fill out our contact form on our website today to connect with a healthcare practice attorney.