What are the Most Common Forms of Healthcare Fraud?

Among the most common forms of healthcare fraud(s) are:

Hospice Fraud: This type of healthcare fraud goes largely undetected, as the patients are most the elderly, terminally ill or incapacitated. Hospice fraud includes:

  • Admitting non-terminal patients. This is particularly unfortunate, since these patients are denied the right to curative medical treatment
  • Certifying consent for hospice care by forging documents or misleading patients
  • Filing claims for non-rendered services
  • Falsifying medical records and billing multiple times for the same treatment

Pharmaceutical Fraud: Giving the skyrocketing medical costs, the pharma industry is ripe for fraud. Whistleblowers have helped the US government recover more than $27 billion generated from fraudulent practices. Examples of such practices, which seem to have become commonplace in large pharma companies, are:

  • Incentives to physicians to prescribe medicines
  • Off-label marketing of drugs for purposes that have not received FDA approval
  • Manipulating data during research trials
  • Not offering the best price to the government

Sleep Center Fraud: Sleep centers or sleep labs that conduct tests for the accurate diagnosis of sleep apnea are often found in violation of the False Claims Act. Among the fraudulent practices adopted by sleep centers are:

  • Double billing for procedures
  • Manipulating PSG test results to falsely show that a patient needs CPAP testing
  • Offering incentives for referrals
  • Submitting bills for in-lab tests, while conducting in-home tests