Thu. Feb 29th, 2024

There are many kinds of health fraud, but fraud committed by fraudulent service providers is the most prevalent and most costly one. Who are they? Doctors, nurses, pharmacists, etc. whoever orders or delivers medicines, equipment, or treatments. That’s right; the physicians on whom we rely and trust also bear the responsibility for these crimes. Anyone can be a target, so it is vital that you read and follow our tips on preventing health fraud later in this article.

Common Healthcare Fraud 

There are several instances in which unscrupulous companies commit fraud. Here are some of the most prevalent criminal activities according to


This is whether a treatment is given or a diagnosis is made. However, the insurer pays premiums for a more expensive or severe diagnosis. So tell your doctor to go on a mammogram and then turn around and pay for your insurance or Medicare for a more expensive form of mammogram and further exams. Such tests will be shown and will be included in your medical record. You may end up being cared for based on these kinds of false charges.

Unnecessary Tests or Operations are Performed.

This happens when a service provider is wasteful or has a reason for paying insurance only. Yes, it happens all the time, from diagnostic tests to operations, as repulsive as this is practice. About half of all primary care doctors believe “too much medication,” or too many medications are given to their patients. We are over-tested and handled morally, physically, and emotionally to our detriment. Some of the over-used procedures can be hazardous to the body, such as X-rays and CT scans. Both of them expose you to radiation that is proven to cause cancer too much.


In this field, a doctor marks or mislabels a diagnosis not covered by insurance. This occurs in many cases of strictly cosmetic procedures, such as the argument that a nose job needed to be done due to respiratory issues, a deviated septum, or contentious procedures that have not been accepted. This can lead to unapproved (unknown) systems and higher insurance premiums by physicians.

Purposeful Medical Misdiagnosis

In this case, doctors intentionally misdiagnosed patients, who are usually more severe about their illness or disability than they are so that they can charge them for costlier treatments and procedures. Sadly, elderly and mentally ill people make these secure scheme targets as they are less likely to doubt a doctor’s opinion. Unless you are reported in your health reports, an inaccurate diagnosis will cause you to be treated incorrectly or inadequately.

How to Avoid Healthcare Fraud

Here are three tips to help you reduce your health fraud risk with the help of

Investigate the Employees.

Marketers or individuals who introduce patients to the practice are a vital subject for study. These people, also known as specialists in business development, are physicians, home health agencies, long-term care institutions, and other organizations which provide references. Such individuals will also have no formal training, credentials, or licenses. 

In other words, you won’t lose anything and benefit anything with patient references. Other individuals can be representing patients, health programs, and care providers on your behalf, which you do not know. A federal investigation often starts with an office employee or assistant who sets red flags for auditors and government agencies. Provide an employee reviewed by an enforcement officer or attorney and have a clear compliance plan with the laws of Stark and False Claims.


Providers are also upcoding in possession of the government today. While it is tedious, your billing practices and the status quo of your accounting practices are well worth investigating. Be sure that the paperwork follows every patient’s billing code.

NPS Billing.

Most doctors employ and supervise NPs. An NP who had a clinic in Texas had only paid a $900,000+ back charge for a coder using a visiting code for a physicist if the NP went home alone. All the MD and the NP now face civil and even criminal charges. In most cases, 85% of the coding should be on or under the CMS of MD bills.

The public must be informed about the prevalence and effects of health fraud and what we can do to prevent it. If the audience is conscious of this issue, and no real progress can be made early, we might have a real tragedy. Since seasoned criminals entering the world of health fraud, the crimes committed are even more shocking and common.

“This is a contributed article by James S. Bell, his over 15 years of experience, James S. Bell P.C. has forged a name as a leading United States trial attorney. Most notably, Bell obtained the largest verdict in the United States in 2017 and the ninth (9th) largest verdict in United States history against JPMorgan Chase Bank for in excess of $6,000,000,000 (6 Billion Dollars). “

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