Healthcare fraud
Healthcare Fraud
Healthcare fraud (pronunciation: /ˈhelθˌker frɔːd/) is a type of fraudulent activity that involves the filing of dishonest health care claims in order to turn a profit.
Etymology
The term "healthcare fraud" is derived from the English words "healthcare", which refers to the organized provision of medical care to individuals or a community, and "fraud", which refers to wrongful or criminal deception intended to result in financial or personal gain.
Definition
Healthcare fraud is a crime in which an individual or a group of individuals defraud a healthcare system, such as Medicare or Medicaid, by submitting false or misleading information for the purpose of receiving unauthorized benefits or payments. This can include billing for services not rendered, upcoding (billing for a more expensive service than the one provided), and unbundling (billing each step of a procedure as if it were a separate procedure).
Related Terms
- Insurance Fraud: A broader term that encompasses healthcare fraud. It refers to any act committed with the intent to fraudulently obtain payment from an insurer.
- Medicare Fraud: A form of healthcare fraud specifically targeting the Medicare system. It involves filing false claims to receive unauthorized payments.
- Medicaid Fraud: Similar to Medicare fraud, but specifically targets the Medicaid system.
- Phantom Billing: A type of healthcare fraud where medical providers bill for procedures that were never performed.
- Upcoding: A fraudulent practice where healthcare providers bill for more expensive services or procedures than were actually provided or performed.
- Unbundling: A fraudulent practice where healthcare providers bill each step of a procedure as if it were a separate procedure.
See Also
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