Major Examples Of Health Insurance Frauds That Happened In Clinical Settings

• Fraud Insurance Claims – There are numerous pieces of evidence found that in cases medical services providers claim compensations for services and procedures that were never performed or provided.
• Claims for non-covered medical treatments – Government and private insurance companies authorize a certain set of services to their subscribers. In some cases, healthcare providers tried to trick the system by claiming compensations for procedures that were not authorized.
• Tempered dates and locations – In this type of health care insurance fraud, providers tried to temper the data containing the information about the location and date of the services provided.
• Inaccurate ICD and CPT coding – To support payment claims health care services providers would add extra ICD and CPT codes and try to overcharge for services provided to patients.
• Prescription drug fraud – Prescription drug fraud is one of the major types, costing billions to US healthcare. Forged prescriptions and issuance of medication which was not required is a type of prescription fraud.

Health insurance frauds are not only affecting insurance companies, financial institutions, and government-run programs; these fraudulent activities are also affecting common people who are law-abiding citizens and, pay their insurance premiums in time and have purchased insurance coverage. However, due to fraud, they pay for the medical services which they never availed.

The following chart shows the Manufacturing Industries decline of GDP as the kickbacks increased in the Healthcare Industry

This chart shows the U.S. Trade Deficit grew as the Manufacturing Industry declined.