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Using illegal billing practices for financial gain

On Behalf of | Oct 4, 2023 | Healthcare Fraud

There are certain types of financial crimes that can come with steep penalties, including time behind bars and other consequences. White-collar crimes, including health care fraud, involve committing certain types of deceptive acts that allow a person or party to achieve financial gain. While this specific category of fraud can take many different forms, one often accomplishes it through deceptive or illegal billing practices. 

Medical billing is the process of charging insurance for services provided to patients. Doctors and other types of care providers are responsible for being honest in their billing details, but there are certain actions that may allow providers to get more money than they should. Knowingly or unknowingly engaging in deceptive billing practices can result in, at best, fines and penalties against the responsible party, or at worst, criminal charges and incarceration. 

Common types of deceptive billing practices 

While there are other ways to commit billing fraud, the most common are through upcoding and unbundling. These types of billing practices allow a provider to charge more, which results in higher payments from insurance companies, Medicare and other parties. The differences between these two types of billing fraud include: 

  • Upcoding — Medical practitioners use upcoding when they intentionally include the wrong code in their billing. This allows them to charge for more expensive and complicated services than the ones actually needed by the patient.  
  • Unbundling — This is when the service provider bills for multi-step procedures separately instead of as one procedure. By doing this, they are able to charge more money for individual services instead of one bundled service. 

Fraudulent medical billing practices may also include double billing, which is exactly what the name implies. It happens when a Michigan care provider bills insurance or a patient twice for a service rendered only one time. One way this occurs is by using an individual code as well as the bundled code. 

Defending against health care fraud charges 

Billing fraud and other types of health care fraud can result in penalties that may change the course of a person’s life. If you are facing these allegations or charges that could affect your future, you will benefit from seeking professional guidance regarding your most beneficial defense strategy. An assessment of your case will allow you to understand how you can protect your rights and confront any white-collar criminal charges against you.