Healthcare treatments are typically expensive and take a substantial period of time to conduct. Scammers, on the other hand, take advantage of such causes to deceive the innocent emotionally and, more importantly, financially.
Providers involved in fraud relied on creative schemes such as fake patients, forgery, bribes, quackery, and falsified billings to financially benefit from administrative vulnerabilities in public programmes such as Medicaid or Medicare.
According to a private report, it is estimated that around $10 billion is being lost every year. Healthcare scammers use several deceptive techniques, which lures the contrary person to opt for it most certainly.
However, healthcare scams are generally undertaken by scammers posing as medical providers, patients, and others who use fraudulent techniques to acquire personal and financial information about an individual.
Some common types of healthcare scams one should watch out for are:
- Kickbacks – Kickback is one of the most common techniques used in a Healthcare scam. Legally, it is unlawful for any doctor or medical facility to receive anything of value (e.g., cash or gifts) from another doctor, healthcare promoter, pharmaceutical firm, medical device manufacturer, or anyone else to refer patients at a specific rate to meet a specific quota, to prescribe a specific medication, to use a particular medical device, or to make any decision that may be determined by the offering rather than one based on experience and the client’s best interests.
- Managed Care Organizations – Managed Care Organisations exhibit a standard health care reimbursement situation; the fraud is classified by overbilling, which also creates an incentive to deny care to patients/consumers. In other words, fraud in MCOs arises from enrollment practices through which healthy patients are “recruited” to join specific MCOs, a practice known as “cherry picking.” However, this not only defrauds the insurance company but also bargains patients’ health.
- Billing for services not provided – A common type of Health care or Medicare fraud scheme involves billing for services, including treatment or procedures that were never rendered, such as laboratory tests, X-rays, or medication that was never bestowed. Scammers impersonating healthcare workers also use “upcode” for a variety of medical procedures. For instance, if the payment is made in units of time, the time can be expanded. A minor service can also be upcoded as a more labour-intensive or ubiquitous service.
- Prescribing redundant medication to patients – Typically, scammers prescribe redundant medication to patients to obtain extra cash for further fraudulent activities. Unnecessary prescribing is especially dangerous because it leads to pharmaceutical diversion or the transfer of a controlled substance from a medical professional to an unauthorizing party or individual outside of the traditional supply chain. And also, the sedative issue is mainly exacerbated by drug diversion.
- Unbundling – Unbundling is the practice of submitting bills in a disintegrated fashion in order to surge the reimbursement for several tests or procedures that are required to be billed together at a minimal cost. For example, if a scammer posing as a healthcare provider receives an order for a panel of blood tests for a patient, instead of billing for the panel, the service provider might attempt to increase its income by billing for each test separately, as it would end up being substantial.
How to avoid a healthcare scam?
- Avoid unnecessary drug prescriptions or medical treatment that seems irrelevant to your health issue.
- Refrain from giving out your personal or medical details to anyone undetermined except your health care issuer or medical service provider.
- Avoid concealed calls coming from different numbers because legitimate healthcare firms only have 1-2 numbers to deal with their consumers.
- Refrain from acknowledging offers that are touted by door-to-door or telephone salespeople who tell you that services or medical equipment are free.
- Always provide your healthcare or Medicare identification docket only to those who have provided you with medical services.
- Avoid an offer made by a medical service provider related to healthcare that involves errors and misleading facts about the deal.
Conclusion
Healthcare scams are not being targeted to a single place or country; they have been widespread throughout the world. As it is a sensitive issue, the elderly who require healthcare amenities or treatments as they grow are mainly targeted by scammers. However, to overcome these scams, associate with legitimate service providers in the industry and let them know your requirements for the health care plan.
Also, you can undertake research online on official accounts or governmental websites where you will find a list, or you can ask your family or friends that you can trust if they have any experience in this industry. Because, in the end, it is imperative to look after yourself and the well-being of your loved ones and stay safe from health issues and certain frauds.
AUTHOR’S BIO:
Adrian Willson is a healthcare fraud expert, dedicated to preventing scams and protecting vulnerable populations. He’s a sought-after speaker and author, trusted consultant, and passionate advocate for fraud prevention. With his expertise, Adrian helps individuals and organizations stay vigilant against healthcare scams and protect themselves from harm.
