What is healthcare fraud?
Everyone makes the occasional mistake, especially in an industry as complex as healthcare. Rest assured, inadvertent errors are not considered fraudulent. Healthcare fraud is the intentional, unlawful misrepresentation or deception for the purpose of gaining unauthorized benefits – financial or otherwise. Abuse is defined as reckless conduct that goes against and is inconsistent with acceptable business and/or medical practices resulting in greater reimbursement. Fraud and abuse can compromise patient safety and future care. One example of patient harm is unnecessary, sometimes invasive, medical procedures. A provider who enters false codes on a patient for purposes of greater reimbursement leaves the patient with a false diagnosis being associated with their or their family’s medical history. Common examples of medical and pharmacy healthcare fraud Fraudulent schemes are limited only by the imagination of the individual committing the fraud. Common examples are: • Billing for services
