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Eliminating Waste
Reducing Fraud
Improving Processes | Controlling
Administration Costs | Reducing Fraud
Types of Fraud
Fraud costs billions each year. Some schemes include:
- Phantom billing. Adding otherwise legitimate claim charges
for services never performed or fabricating claims.
- Upcoding. Charging for a more expensive service such as a visit
to a specialist when the patient actually saw a nurse or an intern.
- Doctor shopping. Bouncing from one doctor to another to obtain
multiple prescriptions for controlled substances.
- Providing unnecessary care. Including unnecessary tests, surgeries
and other procedures.
- Misrepresenting services. Performing uncovered services but
billing insurance companies for different services that are covered.
- Unbundling. Charging separately for procedures that are actually
part of a single procedure.
- Masquerading as healthcare professionals. Delivering healthcare
services without proper licenses.
- Identity theft. Using another person's health insurance card
or identification to obtain health care or other services or to impersonate
that individual.
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