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Preventing Health Care Fraud and Abuse

Health care fraud is a key driver of rising health care costs. About 3% of all health care spending — or $68 billion each year — is lost to health care fraud. There are a few types of health care fraud including:

  • Medical Identity Theft. This is the misuse of a person’s medical identity to obtain health care goods, services or funds.  This can include fraudulent prescriptions, billing for services that were never provided or referring patients for unnecessary services.
  • Upcoding. This is when the provider bills for a service of higher complexity than the service that was provided or documented.  For example, a supplier may bill for motorized scooters, but supply manual wheelchairs.
  • Billing for Services not Furnished
  • Others can be found here

Here are some things you can do to help prevent health care fraud and abuse.

  • Review your health care charges. Look over your Explanation of Benefits from your insurer and receipts from your doctor...
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