Healthcare is an expensive system, resulting in many cases of fraud that are difficult or impossible to prevent. The prevalence of healthcare fraud has allowed it to evolve into subtypes, such as upcoding and unbundling. In Colorado, medical professionals and fraud investigators are trained to identify different types of fraud crimes.
Submitting two identical bills for the same service is a double bill. A double charge is made to the same account or two separate charges are made to different accounts.
Billing for a service that never occurred is phantom billing. A medical provider may falsify a bill, skip over the patient and send the bill to the insurer that does not know of the nonexistent service.
Unbundling occurs when a medical professional makes multiple charges for a service that requires one charge. In a medical bill, the services are unbundled and charged separately, which results in higher costs, instead of combining the services into one discounted package.
Upcoding is the act of billing for more complicated, expensive services, which never occurred, in place of simpler, less expensive services. An example is when a doctor performs a routine procedure but falsely bills for an extended procedure that includes extensive wound cleaning.
Medically unnecessary services
Many cases of healthcare fraud involve billing for procedures or diagnoses that did not occur or for treatments that are not needed. Medical providers face termination and permanent banishment from working in the medical field, even after forming a solid strategy for criminal defense.
Each year, millions of dollars are lost in diverse acts of healthcare fraud. Most types of fraud include billing for unnecessary services or exaggerating the costs. Double billing, upcoding and unbundling are a few of the most common types of crimes that result in severe consequences for medical providers and patients.