Question

What recommendations do you have to limit crimes by healhcare professionals?

Answer 1

Healthcare fraud and abuse cases cost the industry billions of dollars a year. Without processes in place to detect and prevent fraudulent activities, healthcare providers could face an investigation that may cost them their reputation and revenue.

Limit crimes by healthcare professionals

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