TEN COMMON HEALTH CARE PROVIDER FRAUD SCHEMES January/February 2013 Charles Piper, CFE, CRT

TEN COMMON HEALTH CARE PROVIDER FRAUD SCHEMES   

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.

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