What are typical health care fraud schemes?
Health care fraud is as varied as the millions of providers and patients. Schemes to cheat the Government include charging for services not rendered or rendered by an unqualified person or improper coding to “upcharge” a patient service in order to obtain a higher reimbursement rate from Medicare, Medicaid, CHAMPUS, or other federally-funded health care programs. Hospitals and other entities that must provide the Government with annual cost reports often provide inaccurate data. If done “knowingly,” that is, in violation of the False Claims Act, these cost reports result in violations of the law. The Medicare laws are also designed to prohibit “kickbacks” or other financial incentives to health care providers for referring or “steering” patients to favored providers. Finally, health care fraud can occur in programs where grants, either from the private sector or the Government, pay for some parts of a patient’s health care or pay for research. Care must be taken in those instances not
