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Fake medical bills format word for Pharmaceutical

there are many different types of healthcare fraud at the end of the day some people just don't have a moral compass and don't have ethical standards some of these people end up in different areas of health care like medical providers these individuals bend the rules for their own personal gain over time healthcare fosters get more creative and their techniques become more extreme hi everyone i'm elia from eutactics and today i'm going to discuss nine methods of medical provider fraud before we get started make sure that you subscribe to our youtube channel by clicking the button below also hit that alert bell icon so when we post new helpful content you get notified the first method is something called double billing double billing happens when a provider submits the same claims for the same service more than once from a fraud perspective the provider tricks the insurance companies to pay the healthcare entity more than the allotted amount it's a method to artificially inflate the number of patients a doctor sees and the practice's bottom line similarly there's another term called unbundling unbundling happens when the healthcare entity submits multiple bills for the same service although this sounds similar to double billing there is a difference unbundling involves billing for each step of a procedure as if they are separate procedures this is also a method to artificially inflate a practice's revenue and profit margins phantom billing is a form of medical provider fraud this method involves billing for services that were never rendered the healthcare provider uses genuine patient information sometimes through employing identity theft to fabricate claims phantom billing can also happen when legitimate claims have charges for procedures or services that never took place a telltale sign of phantom billing is that there's a lack of supporting documentation for the claims for example if there's a lack of documentation such as height and or weight there's a good chance that the claims are billing for a non-covered service through false pretenses as a covered service is another form of medical provider fraud this types occurs when a doctor tries to obtain insurance payments by disguising the treatment they provide as a different medically necessary covered treatment this type of fraud is often seen in the world of cosmetic surgery schemes however the phenomenon also occurs in other realms of medicine especially when it comes to experimental treatments sometimes doctors will treat a patient with an experimental drug but then bill insurance companies using a drug or a code that's accepted up coding is a type of billing fraud where a healthcare entity falsely bills for a higher price treatment than it was actually provided this often requires the accompanying inflation of the patient's diagnosis code the doctor will falsely diagnose a patient in the bills for a more serious condition consistent with a false procedure for example a doctor could intentionally misdiagnose an elderly patient who fell inside a nursing home with head trauma needing a ct scan and blood tests the crooked provider didn't necessarily draw blood or conduct the scan but they falsely reported it on the paper one of the telltale signs of this type of fraud is that an inpatient will mysteriously get better as soon as the insurance coverage runs out similarly some fraudsters perform medically unnecessary services the sole purpose of this is to generate insurance payments to fraudulently increase the provider's bottom line common examples of this fraud scheme includes nerve conditions and genetic testing another similar fraud scheme is when a doctor falsifies a patient's diagnosis and medical records they do this to justify tests surgeries and other procedures that aren't medically necessary unlike up coding doctors who engage in this type of fraud will actually conduct unnecessary procedures deductibles and copayments are areas prone to medical fraud sometimes a doctor will bill a patient for more than the required copay amount when this happens the services are often prepaid or paid in full by the benefit plan under the terms of the managed care account increasing deductibles is not as common as decreasing deductibles waiving patient co-pays or deductibles and over-billing the insurance carrier or benefit plan is one such form of fraud if you'd like to learn more about healthcare fraud and what it might look like reach out to a tactics and you already made it this far into the video so you might as well like it share it and comment below