Crime comes in all shapes and sizes. But hospitals rarely come to mind when most of us think of crime, even the white-collar variety. Unfortunately, doctors and hospitals are also no strangers to the illegal side of doing business.
This ugly facet of the healthcare industry has long been in the shadows. Don’t be fooled. Hospital fraud is not a victimless crime. Greed has no boundaries, and you or a loved one could become victim of this shameful act.
In this article, we’ll discuss hospital fraud and how it affects patients in Florida. If you feel that you’ve been a victim of this crime and have questions, contact a hospital fraud lawyer in Florida. A law firm with experience in hospital fraud can help you to take the legal steps to be compensated.
What is Hospital Fraud?
Hospital fraud occurs when a hospital or healthcare center improperly bills for its services. Depending on their method, the endgame is to increase their profits. Although unscrupulous, hospital fraud does occur. The Federal Bureau of Investigations (FBI) has an entire department devoted to discovering, investigating, and prosecuting this crime.
Hospital fraud can happen in two intentional ways; improper billing or directly involving patient care.
- Double billing – This scam is when a hospital sends two or more separate bills for the same procedure. Double billing is also referred to as unbundling. Many of these false claims get processed and paid as they get lost in the paperwork and are easy to miss.
- Phantom billing – Billing for procedures or services that didn’t occur.
- Upcoding – Upcoding occurs when a procedure is billed for a higher-priced service than the patient received.
- Inpatient vs outpatient care – Private insurance, Medicaid, and Medicare pay significantly more for inpatient procedures than for outpatient care. This inconveniences the patient and can also lead to hospital overcrowding.
Deceptive billing doesn’t necessarily cause direct physical harm to the patient. However, other forms of hospital fraud do.
- Unnecessary tests or procedures – The falsification of patient records to justify tests or procedures to drive up costs. Referred to as overtreatment, this can risk the patient’s health, especially when unneeded invasive surgery is performed.
How Does Hospital Fraud Affect Patients and Society
For patients who trusted their healthcare professional’s diagnosis and underwent unnecessary surgery or procedures, they’ve been put in harm’s way for the sake of profits. Not only is this completely unethical and against the Hippocratic Oath, but it’s also a violation of trust.
Although not as obvious as subjecting a patient to unnecessary procedures, hospital fraud affects all of us in other ways. What seems like a crime solely against insurance companies and Medicaid or Medicare can hit everyone in the wallet in other ways.
- Health insurance premiums can increase – The health insurance industry is a for-profit business. When the costs of the claims they need to pay increase, they will usually increase the premiums charged to individuals.
- Increase in local taxes – Medicaid and Medicare are funded by payroll taxes and by Federal government money. When the burden of paying for fraudulent claims increases, it could cause your State and Federal taxes to increase.
- Public perception of the healthcare industry – Unfortunately, as more and more hospitals and healthcare facilities are exposed for their fraudulent activities, the public’s perception of hospitals and doctors can have them questioning their expertise.
Hospital Fraud Whistleblower Lawsuits
The False Claims Act allows individuals who believe they’ve experienced or have evidence of hospital fraud can file a lawsuit on behalf of the Government. The Qui Tam provision of the False Claims Act allows a person with knowledge of hospital fraud that defames the government to sue and recover a percentage of monetary fines and penalties imposed on the hospital.
Hospital Fraud Affects Everyone
What seems like a crime that only hurts the government or insurance companies can hit all of us directly in our finances. From increased medical insurance premiums to pay more in state and federal taxes, hospital fraud does affect the average Floridian.
If you have knowledge of hospital fraud, contact a law firm with experience with this type of case. You may be awarded money for your information along with helping to do your civic duty that could help to keep everyone’s medical insurance premiums and taxes affordable.
