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Signs of Fraud in the Healthcare Industry

Signs of fraud in the Healthcare Industry

What is fraud ?

Fraud is an intentional illegal act or action in order to gain unauthorized & unfair gain or profit either individually or for an institution. In simple words, Fraud is a Crime.

What is healthcare fraud ?

Healthcare fraud is the act of filing fraudulent health claims on government or private institutions in order to gain either personal profits or financial funding. It could be done by various means to different degrees depending upon the person conducting such a crime and it affects the country as a whole.

Although fraudulent claims in the United States are not high in quantity, but the price tag involved in the individual claims is so high that it alone costs tens of billions of dollars every year.

Government healthcare fraud is the most common and easy to commit due to the presence of so many complex nature of government health programs which includes- Medicare, Medicaid, and TRICARE.

Most of the fraudulent cases are filed by individuals who are not even looking for such frauds. They are just normal citizens working on their daily life and suddenly just came across such suspicious fraud or patterns or signs of healthcare fraud around them. These persons are known as whistleblowers (also written as whistle-blowers or whistle blower). A whistleblower gets a share in the costs of damages and penalties recovered by the government.

If you or any of your family members have seen or experienced such healthcare fraud, and you have the courage to blow a whistle against someone, Lawyer 4 Help healthcare fraud lawyers will fight and protect you to get you full and fair compensation for your contribution.

Signs / Symptoms of healthcare frauds:

There are various ways to defraud the government or private institutions for healthcare fraud and these ways left some sort of signs and patterns behind that any individual must be aware of and should look after.

  • Billing for services not rendered or provided
  • It is a common form of healthcare fraudulent in which billing is charged for the service which is never been happened or provided at all.

  • Overbilling or Upcoding of service
  • Upcoding means charging expensive claims intentionally from the government than the actual service provided to the person.

  • Overbilling or Upcoding of items and products
  • It is somehow similar to the upcoding of service but the only difference here is that it involves the use of medical equipment, not the service itself. For example- Cutting the big for a fully powered wheelchair but actually providing the manual wheelchair to the patient.

  • Billing for unnecessary procedures or services
  • The government has a responsibility of paying for the service or procedures that are necessary and reasonable enough for the diagnosis but sometimes billing is charged for unnecessary procedures which are not even close enough to the criteria of diagnosis such as an echocardiogram billed for a patient with a sprained ankle.

  • Unbundling of services
  • It is also known as fragmentation. Under this, the one whole procedure is divided into small tasks and is charged separately but in reality,it should be charged as one single procedure only.Using this, medical providers can claim for more amount as each divided task of the whole procedure is claimed separately by them.

  • Paying kickbacks
  • Kickbacks are the type of compensation or rather we say bribery that counts as illegal for the treatment or improper service received. It includes anything of value- money, expensive gifts, car, vacation, or credit.

  • Prescribing unnecessary medications
  • It is very common for people to not report incidents of suspected healthcare fraud because they have no knowledge of reporting the same. But now as we know about all the signs and symptoms of healthcare fraud, it’s time to know - How to report the frauds!

Reporting fraud:

If any healthcare provider or patient or anyone has witnessed or experienced any healthcare fraud, he or she can do any of the following

  • Should tell the higher authority of the company or organization where fraud is being occurred.
  • Could file a lawsuit against it directly by reporting it to the FBI for the same.
  • Or if he or she wants the government to investigate the same, then they are highly stimulated to contact legal counsel from the best firm that specializes in qui tam litigation or healthcare fraud lawsuit under the False Claims Act.


Healthcare fraud is a serious white-collar crime and it damages the financial liability of the whole country if seen from a wider point of view.

If you see or suspect any fraud in the healthcare industry, you should immediately report the same and not be afraid to come out and just blow the whistle against such frauds.The rules and procedures for healthcare fraud lawsuits are so complex and involve so many parties that it is difficult to solely handle it alone, only the experienced and best attorney for Personal injury & Medical malpractices can face such challenges and procedures.

Lawyer4Help has a complete understanding and will provide the right guidance for all Medicare and healthcare fraud. Call us today to discuss how we can help you get the right claim.

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