Another way health care providers might commit healthcare fraud is by billing for unnecessary treatments. This happens when a provider orders extra tests or services that are not necessary for the patient’s condition or symptoms. For example, an emergency room doctor may automatically order a barrage of tests for every admitted patient, even if the patient does not require them.
Billing for unnecessary treatments is often connected with illegal kickback schemes. A kickback scheme is when money, perks, vacations, or other items of value are offered by a person or business in exchange for doctor’s referral of patients for treatment. For instance, if a pharmaceutical company gave a doctor money for every new prescription the doctor wrote for the company’s drug, both parties would be guilty of participating in a kickback scheme. In 2010, two North Carolina doctors filed a qui tam law suit alleging that the owner of their hospital offered kickbacks to doctors who would routinely order a barrage of unnecessary tests for emergency room patients, and who admitted more senior citizens and Medicare patients, regardless of medical necessity.
Links:
- FBI: Financial Crimes Report to the Public - Health Care Fraud
- Charlotte Observer, Doctors allege for-profit owner of two local hospitals committed Medicare fraud and offered kickbacks
