Healthcare treatments can be costly and time-consuming, and unfortunately, scammers take advantage of this to deceive people emotionally and financially. These fraudsters employ various schemes, such as fake patients, forgery, bribes, quackery, and falsified billings to exploit administrative weaknesses in public programs like Medicaid and Medicare for their own financial gain.
Reports suggest that healthcare scams result in losses of around $10 billion per year. Scammers use various deceptive techniques to lure unsuspecting victims, but they typically pose as medical providers or patients and use fraudulent methods to obtain personal and financial information from individuals.
Some Healthcare Scams to be Aware of
Here are some healthcare scams that individuals should be aware of:
- Managed Care Organizations – Fraud in MCOs arises from enrollment practices, where healthy patients are recruited to join specific MCOs, a practice known as “cherry picking.” This defrauds the insurance company and also compromises patients’ health.
- Unbundling – This is the practice of submitting bills in a disintegrated fashion to surge reimbursement for several tests or procedures that are required to be billed together at a minimal cost. Scammers bill for each test separately to increase their income.
- Kickbacks – It is unlawful for doctors or medical facilities to receive anything of value, such as cash or gifts, from healthcare promoters, pharmaceutical companies, medical device manufacturers, or anyone else to refer patients at a specific rate, prescribe specific medication, use a particular medical device, or make any decision based on the offering rather than the client’s best interests.
- Prescribing redundant medication to patients – Scammers prescribe unnecessary medication to patients to obtain extra cash for further fraudulent activities. This leads to pharmaceutical diversion, the transfer of controlled substances from a medical professional to an unauthorized party, and exacerbates the sedative issue.
- Billing for services not provided – This involves billing for services, such as laboratory tests, X-rays, or medication that was never given. Scammers impersonating healthcare workers also use “upcode” for a variety of medical procedures.
Ways to Avoid a Healthcare Scam?
To prevent falling victim to healthcare scams, it is important to follow certain precautions.
- First, do not accept any unnecessary drug prescriptions or medical treatments that do not address your specific health concerns.
- Additionally, avoid sharing personal or medical information with unknown individuals, except for your healthcare provider.
- Beware of calls from unknown numbers as legitimate healthcare providers typically only have one or two contact numbers.
- Avoid accepting offers from door-to-door or phone salespeople who claim that their services or medical equipment are free.
- Only provide your healthcare or Medicare identification information to trusted medical service providers who have provided you with services.
- Finally, be wary of healthcare providers who make false claims or use misleading information to persuade you to accept their services.
Healthcare scams are a global problem that affect people in many countries, not just one particular place. These scams often target the elderly, who are in need of healthcare services and treatments as they age.
To protect yourself from healthcare scams, it’s important to work with reputable healthcare providers and let them know your specific needs and requirements for a healthcare plan. This can help you avoid falling victim to scams and ensure that you receive the care you need from trustworthy sources.