What is considered Health Care Fraud?
The most common kind of fraud involves a false statement, misrepresentation or deliberate omission that is critical to the determination of benefits payable. The most common examples of health care fraud include, but are not limited to: • Billing for services, procedures and/or supplies that were not provided. • Ordering services that are unnecessary or unwarranted for the purpose of financial gain. • The intentional misrepresentation of any of the following for purposes of manipulating the benefits payable: • The nature of services, procedures and/or supplies provided. • The dates on which the services and/or treatments were rendered. • The medical record of service and/or treatment provided. • The condition treated or diagnosis made. • The charges or reimbursement for services, procedures, and/or supplies provided. • The identity of the provider or the recipient of services, procedures and/or supplies. By its nature, health care fraud revolves around the exploitation of patients and
