The Five Major Types Of Health Care Fraud

Health care fraud is an ever growing problem with in our country. This is not a new issue, nor an issue that will ever go way. According to the Federal Bureau of Investigations (FBI) health care fraud cost tax payers two hundred and seventy two billion dollars in 2013 (Federal Bureau of Investigations, 2016). The numbers have continued to increase. When discussing health care fraud we need to know what exactly we are discussing. There are many different types of health care fraud. This paper will give an overview of the five major types of health care fraud. The different types occur on both the patient/consumer level and at the provider level. According to the Centers for Medicare & Medicaid Services (CMS) the five major types of health

Over the past 5 years the Medicare Fraud Strike Task Force has charged thousands of medical personal who were knowingly defrauding the Medicare system of billions of dollars (U.S. Department of Health & Human Services, 2016).

Billing for services or items not furnished. This type of health care fraud is also most prevalent in the Medicare setting. This type of fraud, similar to billing for unnecessary services or items, is also being committed by the providers. False claim schemes are the most common type of health insurance fraud. The goal in these schemes is to obtain undeserved payment for a claim or series of claims. (Centers for Medicare & Medicaid Services, 2015)

Upcoding. Upcoding is a form of fraudulent medical billing. Upcoding refers to a practice in which a provider bills a health insurance payer (whether private, Medicaid or Medicare) using a CPT (Current Procedural Terminology) code for a more expensive service than was performed. It's a fraudulent practice used by providers who are trying to cheat the system so they will be paid more money than they have negotiated with those

With more health care records and information being stored electronically, there is more access to personal information that can be stolen and used for fraud purposes. In order to get a handle on this issue private citizens need to be further educated on what health care fraud is and how to prevent as well as report it. Health care professional are on the front lines of health care fraud and need to become proactive in being able to spot and report suspicious activity. With these actions taking place there can be a reduction in the amount of health care related fraud every