Fraud & Abuse of Patient Information

Fraud and abuse of patient information are widespread in the United States, according to Quackwatch, which estimates their cost at $100 billion a year. Medicare and private insurance often fall victim to fraud through false claim scams.

Billing Fraud

• Billing fraud includes billing for services, procedures and medical supplies when they are not provided to the patient. Some physicians charge insured patients more than the standard charge and represent the higher fee to the insurance company. Double billing also occurs when physicians charge for the same service more than once.

Misrepresentation of Services

• Some physicians misrepresent services and bill for more care than was provided. They have the ability to alter dates of service, conditions, diagnoses and the charges involved. This can be done through medical billing coding that does not apply to the correct procedure or service.

Unnecessary Testing and Services

• Fraud and abuse of patient information are also done through unnecessary testing and services. Some physicians receive kickbacks for referring patients, whether they need the services or not. This leads to false medical information in a patient's chart, and it's considered fraud and abuse of patient information.