Health care fraud is as varied as the millions of providers and
patients.
Schemes to cheat the Government include charging for
services not rendered or rendered by an unqualified person or
improper coding to “upcharge” a patient service in order to obtain
a higher reimbursement rate from Medicare, Medicaid, CHAMPUS, or
other federally-funded health care programs. Hospitals and other
entities that must provide the Government with annual cost reports
often provide inaccurate data. If done “knowingly,” that is, in
violation of the False Claims Act, these cost reports result in
violations of the law. The Medicare laws are also designed to
prohibit “kickbacks” or other financial incentives to health care
providers for referring or “steering” patients to favored
providers.
Finally, health care fraud can occur in programs where
grants, either from the private sector or the Government, pay for
some parts of a patient’s health care or pay for research. Care
must be taken in those instances not to “double bill” both the
Government and a private payor and to accurately report the
research processes and findings.
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