Medical billing is very important for the healthcare department and the patients too. In this case, the fraudulent practices are rife. If you are a part of pre-certification in medical billing, you might find too many loopholes in that, and it will make you understand how the scams can be made by these vents.
It is also very evident that each year the government loses so much in the fraud cases of medical bills, and it’s not just one but there are several different types of fraudulent practices out there. If you are unaware of the same, then here, we have listed some of it for you to understand the same the next time you see it and report it.
- Upcoding
In the practice, if pre-certification services medical billing, you must have heard the word upcoding which means if a patient has a treatment for a sprained ankle, but in the bill, it’s mentioned as broken. This is a great scam of the billing services and this means more money from the customers unethically. There are codes for every situation and that’s why the computerized frauds are very common. If the patient does not look at the bill properly they will end up paying more than they are supposed to pay. The unfortunate case is every year this same thing is happening in so many healthcare places.
- No bill rendered
You might think that why would this kind of thing happens, but in reality, it happens in so many rural hospitals, where no bills are given to the patient. They are charged by some verbally spoken amount and they have to pay it. This very thing is a part of fraudulent practice in healthcare centers. If you face a situation similar to it, you must ask for the proper bill from the clinic or hospital, and it will be better if you ask about the cost of treatment beforehand from the place.
- Phantom bills
This is another fraudulent practice where a person receives a medical bill for no service rendered to them at all. It can happen even though the person has paid their bill, they might get one mentioning the things that were never actually performed. This very thing takes places for so many people and they get confused by the same. It’s a certain hassle for people, and every year millions of dollars are spent to stop this kind of scam.
- Inflated bills
It happens that sometimes a patient gets a bill of an extra amount which is supposed to get covered by their insurance. This case happens with so many people and this can be solved by billing investigators, who can demand the proper accounting of the amount to be paid.
- The unbundling of services
This happens when multiple services are billed separately and it creates a higher amount for the patient to pay. This is a very calculated process of fraudulent practice, where a person will get confused by too many bills, and finally, they will have to pay for everything in the bill.
Take note of the above-mentioned fraudulent practices in medical bills, and there is another which is self-referrals. In here, the doctor refers to a person for a test from where he or she will get financial compensation.
