Fraud is a huge threat to health care organizations which can have serious, long-term implications. All health care providers should have a clear understanding of health care fraud and know how to protect themselves and ensure compliance. With this in mind, here is everything you need to know about health care fraud.
How serious is health care fraud?
Health care fraud costs the United States around $68 billion every year according to recent statistics. It is considered a serious felony and carries heavy penalties including fines costing thousands of dollars and lengthy imprisonment. Along with this, health care organizations or individuals facing accusations of health care fraud are also likely to experience long-term repercussions with regards to a damaged reputation and poor job prospects. For that reason, health care providers must be equipped with the knowledge to identify and prevent issues of health care fraud.
What is health care fraud?
Health care fraud is a broad term that covers many different activities. In summary, health care fraud is when an organization or individual knowingly engages in fraudulent activity with the intent of making a profit. However, only a small percentage of instances involving health care fraud are carried out by dishonest health care providers. Many health care fraud investigations are the result of mistakes, accidents, or omissions. According to the las vegas healthcare fraud group law firm, some common examples of health care fraud include submitting multiple bills, billing for unnecessary services, accepting money or kickbacks, and ordering medication without the approval of a physician.
How to prevent health care fraud
Fortunately, there are many ways for health care organizations to protect themselves from fraud. The first step to effective fraud prevention is to have a strong compliance program in place. This should outline what policies you have developed to prevent fraudulent claims and ensure compliance. Not only will this provide a written document of your intent to uphold ethical practices, but it will also encourage employees to report suspicious activity. As part of the compliance scheme, health care providers should have clear policies in place to monitor and detect suspicious activity in the workplace. For instance, health care fraud detection software can be installed to constantly monitor claims and notify managers of any potentially fraudulent or incorrect claims before they are submitted.
What to do if you suspect health care fraud
If you suspect health care fraud, then you must report it to the appropriate authorities immediately and contact your insurance company to notify them of your concerns. They will carry out an independent investigation and contact other departments if necessary. Make sure that you retain any documentation and information that may be needed as part of the investigation. You may also want to carry out an internal investigation to determine the potential seriousness of the issues involved. If you are accused of health care fraud, then you should contact a specialist health care fraud law firm straight away to discuss your situation and get expert legal advice.
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