• Billing for services not rendered
• Billing for services not medically necessary
• Double billing for services provided
• Upcoding (e.g., billing for a more highly reimbursed service or product than the one provided)
• Unbundling (e.g., billing separately for groups of laboratory tests performed together in order to get a higher reimbursement)
• Fraudulent cost reporting by institutional providers

Kickbacks in return for referring patients or influencing the provision of health care are other common schemes. The anti-kickback statute prohibits the payment of kickbacks for the purpose of inducing the referral of services which are paid for by federal health care programs. Kickbacks corrupt the decision making of medical providers, placing profit above patient welfare. They can lead to grossly inappropriate medical care, including unnecessary hospitalization, surgery, tests, and equipment.

Other types of schemes include providing services by untrained personnel, failing to supervise unlicensed personnel, distributing unapproved devices or drugs, and creating phony health insurance companies or employee benefit plans.

The following law enforcement agencies investigate health care fraud:

• City, County, State and Federal Law Enforcement Agencies
• Justice Department through the Assistant
• U.S. Attorney Generals Office
• Federal Bureau of Investigation (FBI)
• Postal Inspectors
• Department of Health and Human Services (HHS)
• Food and Drug Administration (FDA)
• Offices of Inspectors General (OIG)
• U.S. Department of Labor
  

If you or a loved one has been approached by law enforcement investigating healthcare fraud in Florida, contact Mr. Edelstein today for a FREE CONSULTATION.