As a healthcare provider—whether you’re a pediatrician, an allied health worker, a registered nurse or any other specialty—you work hard to provide top-notch care for your patients. Yes, the medical industry is a business at its core. But it’s also an opportunity to use your expertise to help people get and stay healthy.
When you think of insurance, the first thing that jumps to mind is the various safeguards you have in place to protect your practice from financial ruin, including medical liability insurance, property insurance, business interruption coverage and workers’ compensation (if you employ others).
It may not have even occurred to you that some healthcare professionals engage in fraudulent activities for the immediate gratification of an illicit payoff at the expense of insurance companies and policyholders. There’s even a spectrum of fraud; soft fraud involves exaggerating a legitimate claim while hard fraud involves staging or outright fabricating an event for a claim.
Sometimes professionals even convince policyholders to commit insurance fraud. In a recent case out of Minnesota, seven chiropractors have been charged with fraud for their part in a scam meant to take advantage of the state’s no-fault insurance policy. Basically, regardless of who’s found at fault for an auto accident, policyholders involved are guaranteed at least $20,000 in medical coverage.
These allied health professionals were allegedly recruiting people via “runners” who had either been in a car accident or who would say they had been in one. As the Star Tribune reports, “They then submitted insurance claims and received reimbursements for services that were either not medically needed or were never rendered, according to the charges.”
Earlier this year, over 400 healthcare professionals were charged in a year-long fraud operation, many of them for activities like allegedly writing unnecessary opioid prescriptions for patients and later billing Medicare for these false claims. In South Florida alone, 77 healthcare professionals were charged with submitting false billings for pharmacy fraud, mental healthcare and at-home healthcare to the tune of $141 million.
According to the Association of Certified Fraud Examiners, these are some of the most common ways health care providers engage in fraudulent insurance scams:
-Billing for services not rendered
-Billing for a non-covered service as a covered service
-Kickbacks and bribery
Statistics from the United States Sentencing Commission show that over 71 percent of health care fraud offenders were sentenced to imprisonment in 2015, with the average sentence length being 31 months. Besides potential jail time and financial damages, healthcare providers who engage in fraud will undoubtedly suffer reputational damage and loss of trust from their patient base.
Health care providers can engage in fraudulent claim submissions that make them money in the short term but carry long-term consequences. Or medical professionals can use business insurance for legitimate financial protection against general liability, property damage and workplace injuries. Only one of these options holds their patients’ best interests at heart.
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