Health insurance billing requires medical professionals to maintain detailed records of their patients and treatments. Suspicions of submitting a false claim may occur if a patient files a complaint about services or fees.
Allegations of unnecessary treatments or inflated invoices may fall under the scrutiny of federal insurance investigators. According to the Department of Justice, health care providers facing fraud allegations settled claims worth more than $2.2 billion in 2020.
Health care providers may find themselves under investigation
With health insurance premiums and out-of-pocket payments increasing, patients tend to ask more questions. Concerns may arise over services and billing statements. If a practitioner’s treatment appears unrelated to a medical issue, a patient may dispute the fees.
A patient dispute, however, may result in an insurance provider beginning an investigation. If an investigator finds an error or a problematic claim, they may submit the case to federal officials for further review.
Officials charge dentist with claims fraud
A dentist allegedly submitted false insurance invoices claiming, for example, that he performed “complex” tooth extractions. As reported by the Lexington Herald-Leader, his guilty plea to fraud reflected investigators determining that he instead performed “simple” and unneeded extractions. The alleged exaggerated claims resulted in higher insurance reimbursements.
After admitting to submitting claims for inflated services for about 15 years, the dentist found himself sentenced to four months in prison. He also agreed to repay more than $70,000 to taxpayer-funded Medicaid and $20,000 to the government.
The dentist’s sentence requires home detention for six months upon release from his four-month incarceration. Had he not decided to plead guilty, however, he may have received a much more severe sentence.