Medical professionals, not patients, commit most insurance fraud

As an employee in a medical office, you are probably always on the lookout for fraud. You want to make sure that people give accurate information about themselves and their insurance policy. You may be so busy scrutinizing the behavior of clients that you never stopped to think about whether or not your employer or co-workers might engage in fraud.

While patient fraud does sometimes occur, health care provider insurance fraud is far more common. You can potentially wind up charged with a white collar crime if your employer involved you in an insurance fraud scheme.

What are some red flags for illegal insurance practices?

As a billing specialist or records employee, you might receive questionable requests from medical professionals or people in positions of corporate authority at the company. You probably already realize that billing for a service that a doctor didn’t perform or an appointment that didn’t occur is fraud.

What you may not realize is that there are other, more subtle ways that billing can lead to insurance fraud. Choosing to charge for more expensive but slightly different procedures or treatment is a common form of fraud.

Unbundling is also a practice that your employer might require of you that violates the law. Certain procedures get billed as a unit because they always occur together. This allows for savings for the patients and insurance providers. Unbundling and billing for individual services is a common form of fraud.

If you suspect that your employer has you doing illegal things to turn more of a profit, you might want to talk with a lawyer about your concerns in order to protect yourself.