Fraud Archives

Short Dr. Visit – Is this Cheating?

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I go to see the Physician, wait in the waiting room for quite a long time. Dr. comes in and does not sit down and stood at the door with his hand on doorknob as if he was getting ready to open the door and leave, making it a short visit. This short visit resulted in a high charge. I made it a point to not stand and tried to have a discussion. After a few minutes I stand which signaled to him that the session was over and he open the door and left, resulting in a high charge.

This doctor charged Medicare $450 for the session, which was a typical example of a short visit with a high charge. He turned in code 99214 Office/Patient Visit Est. Level 4, showcasing how a short visit can have a high charge.

Would this be considered Fraud? Feel free to leave your response via the comment section.

False Claims Act Settlements and Judgments Exceed $2.68 Billion in Fiscal Year 2023

Wow! The False Claims Act exceeded $2.68 billion in settlements and judgments in 2023.

Settlements and judgments under the False Claims Act exceeded $2.68 billion in the fiscal year ending Sept. 30, 2023, Acting Associate Attorney General Benjamin C. Mizer and Civil Division Principal Deputy Assistant Attorney General Brian M. Boynton announced today. The government and whistleblowers were party to 543 settlements and judgments, the highest number of settlements and judgments in a single year. Recoveries since 1986, when Congress substantially strengthened the civil False Claims Act, now total more than $75 billion.

“Protecting taxpayer dollars from fraud and abuse is of paramount importance to the Department of Justice – and these enforcement figures prove it,” said Acting Associate Attorney General Mizer. The impact of the False Claims Act exceeded $2.68 billion also demonstrates its effectiveness. “The False Claims Act remains one of our most important tools for rooting out fraud, ensuring that public funds are spent properly, and safeguarding critical government programs.” Read More

What to Do When Your Patient Records Contain Wrong Information

Errors in patient records can have serious consequences, but you have the power to correct them.

Patient records are the backbone of healthcare, guiding diagnoses, treatments, and insurance claims. But what happens when these records contain errors—wrong diagnoses, incorrect medications, or even fabricated information? These medical records errors can lead to compromised patient records causing misdiagnoses, improper treatments, and financial headaches. In this post, we’ll explore how to address inaccuracies in your medical records, including what to do if a provider refuses to correct them or if you’re no longer their patient.

Can Wrong Information in Patient Records Be Corrected?

Yes, under federal law, you have the right to request corrections to errors in your medical records. The Health Insurance Portability and Accountability Act (HIPAA) grants patients the right to access and amend their protected health information (PHI). According to the U.S. Department of Health and Human Services (HHS), you can request an amendment if you believe your records contain inaccurate or incomplete information.

Steps to Correct Errors:

1. Review Your Records: Request a copy of your medical records from your provider. HIPAA requires providers to give you access within 30 days, though some states have shorter timelines.
2. Identify Errors: Document the inaccuracies, noting specific details like incorrect dates, diagnoses, or treatments.
3. Submit a Written Request: Contact your provider in writing, clearly explaining the errors and providing evidence (e.g., lab results, second opinions) to support your correction. Include your contact information and a request for confirmation of the amendment.
4. Follow Up: Providers must respond within 60 days (with a possible 30-day extension). They may agree to amend, partially amend, or deny your request.

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FBI News and Multimedia

Health Care Fraud – FBI

Health care fraud can be committed by medical providers, patients, and others who intentionally deceive the health care system to receive illegal benefits or payments.

Health care fraud is not a victimless crime. It affects everyone—individuals and businesses alike—and causes tens of billions of dollars in losses each year. It can raise health insurance premiums, expose you to unnecessary medical procedures, and increase taxes.

The FBI is the primary agency for investigating health care fraud for both federal and private insurance programs. See More

Medical Fraud Exposed

Category Archives: Fraud