Hospital Billing Fraud: What You Must Know about Illegal Hospital Billing PracticesAugust 20, 2018
We trust hospitals for critical medical care. When the bills for that care start to come in, however, questions about charges can arise. Knowing the warning signs of hospital billing fraud – and what to do if you’ve been the target of it – can help you take the right actions to:
- Protect your legal rights
- Report the fraud to the proper authorities
- Hold hospitals liable for their fraudulent billing practices.
What Is Hospital Billing Fraud?
Hospitals (and other health care providers) use billing codes, known as Current Procedural Terminology (CPT) codes, to represent the medical services administered. Maintained by the American Medical Association (AMA), CPT codes are meant to simplify the claims process while providing a universal “language” for describing medical services on bills.
When hospitals intentionally misrepresent the services billed for in an effort to collect more money, they are committing billing fraud.
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Types of Hospital Billing Fraud
Hospital billing fraud can take many forms, including:
- Billing for services not rendered – According to a report from the U.S. Government Accountability Office (GAO), this is the single most common type of overall health care fraud, as well as hospital billing fraud. About 43 percent of hospital billing fraud schemes involve billing for services that were never provided.
- Billing for unnecessary medical services – The GAO reports that this is the second most common hospital billing scheme, with about 25 percent of cases involving billing for medical services that were not necessary.
- Double billing – This can involve billing for the same service multiple times on a single bill or submitting the same bill multiple times for a single procedure or service.
- Upcoding – This illegal practice occurs when a billing code for a more complicated or lengthy service is used when, in fact, a simpler service was provided. For instance, routine treatments or tests may be upcoded as emergency procedures or complicated tests in order to bill at higher rates.
- Unbundling – This involves itemizing services that are usually grouped together.
According to the GAO, more than 2 in every 3 cases of hospital billing fraud involve more than one scheme, and about 61 percent involve 2 to 4 schemes.
What to Do When You Suspect Hospital Billing Fraud
- Contact the hospital billing department to ask about the suspect charge(s).
- Keep all bills, records, emails and correspondence you receive from the hospital.
- Report the suspected fraud to your health insurance provider.
- Contact the Amaro Law Firm for a FREE, confidential, no obligations consultation. We can help you determine if you have been the target of hospital billing fraud and identify your legal options for holding the hospital accountable.
A Texas Medical Billing Fraud Lawyer at the Amaro Law Firm Is Ready to Help You: Contact Us
If you or a loved one has been subjected to any type of medical billing fraud, contact a Houston medical billing fraud lawyer at the Amaro Law Firm for experienced help pursuing compensation and justice.
Call (713) 352-7975 or email our firm for a FREE consultation.
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