What are the most common types of provider fraud?
The most common types are intentional misrepresentations, such as: • Billing for services not provided • Double billing • Billing for services performed by non-licensed persons • Inflated billings • “Unbundling”, or billing separately for component parts of a medical procedure • “Upcoding”, or billing for a higher level of service than what was performed • Billing for services originally advertised as “free” • Over-Utilization of services • Billing non-covered services as covered services Other examples of fraud include: • Waiving deductibles and copays (i.e., “I’ll take what the insurance pays” or “I’ll just add a few services to cover the deductible”) • Prescribing, then offering to buy back powerful narcotics after the insurance has paid for the prescription
