FRAUD SCHEMES of [Fewer] Medical Providers

[TOP TEN IN HEALTH CARE]

Sponsor: http://www.CertifiedMedicalPlanner.org

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By Dr. David E. Marcinko MBA CMP®

  1. Billing for services not rendered.
  2. Billing for a non-covered service as a covered service.
  3. Misrepresenting dates of service.
  4. Misrepresenting locations of service.
  5. Misrepresenting provider of service.
  6. Waiving of deductibles and/or co-payments.
  7. Incorrect reporting of diagnoses or procedures (includes unbundling).
  8. Overutilization of services.
  9. Corruption (kickbacks and bribery).
  10. False or unnecessary issuance of prescription drugs.

[Source]: Charles Piper; CFE CRT January/February 2013 ACFE

Related: https://medicalexecutivepost.com/2020/10/01/healthcare-fraud-and-abuse-costs-and-cases-rose-in-2019/

More: https://medicalexecutivepost.com/2017/05/03/combating-healthcare-fraud/

Update: https://medicalexecutivepost.com/2021/04/24/fraudsters-phishing-for-physician-signatures/

ASSESSMENT: Your thoughts are appreciated.

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