How to Identify Provider Fraud

Fraud is a deliberate deception or misrepresentation that someone makes in order to receive benefits he or she does not deserve.

The large majority of doctors and other health care providers are honest and hardworking people whose only concern is your health. Unfortunately, a few providers engage in fraudulent billing.

Examples of fraudulent billing practices include:

•	Billing for services or items that were never provided
•	Billing separate claims for services that should be billed together as a single item
•	Billing for services or equipment that are more expensive than what was supplied
•	Continuing to bill for home medical equipment after it has been returned
•	Scheduling unnecessary office visits or ordering unnecessary x-ray, laboratory or other services
•	Taking payment from another provider in exchange for referring a patient
•	Allowing an unlicensed person to perform treatment and billing as if a qualified individual had performed the service.

Waste, Abuse and Fraud

  • Definitions of Waste, Abuse and Fraud

  • How to Identify Recipient Fraud

  • How You Can Help Detect and Prevent Fraud