Small mistakes by health care professionals and their support staff could potentially lead to major legal issues. Seemingly insignificant decisions that might seem like smart business moves can technically constitute health care fraud.
Billing specialists and licensed medical professionals, as well as practice managers, could potentially be at risk of federal criminal prosecution over allegations of health care fraud. Charges related to health care fraud often involve claims of improper end fraudulent billing practices.
In recent years, there has been an increased focus on phantom prescriptions issued by licensed medical doctors. Do phantom prescriptions constitute health care fraud?
Phantom prescriptions can lead to fraud
The decision to write so-called phantom prescriptions is not automatically fraud but can lead to fraudulent conduct. Unfortunately for those seeking a black-and-white answer about fraudulent medical billing, review on a case-by-case basis is often necessary to determine if a crime occurred.
Phantom prescriptions involve a physician issuing a prescription without having an in-person appointment with a patient. Calling in a prescription renewal to the pharmacy is not a phantom prescription. Recommending a new course of antibiotics to a patient prone to infections after a video visit or phone call is a phantom prescription.
In some scenarios, phantom prescribing goes hand in hand with fraudulent conduct. A physician or the specialist working at their office may bill an insurance company or government insurance program for an in-person appointment that didn’t technically occur. The worker’s goal may be to legitimize the prescription or increase revenue, as digital visits may lead to lower compensation in some cases.
If there is an attempt to obfuscate the origins of a prescription by creating a false or altered appointment record, that could potentially result in health care fraud allegations. Simply issuing a prescription for a medication without being in the same room as a patient is not necessarily health care fraud.
A similar practice at the pharmacy level could also lead to fraud allegations. If professionals at a pharmacy fabricate records to make it look like there was a prescription received that perhaps a patient did not come to pick up to bill insurance for that prescription, that could also constitute fraud. Allegations of health care fraud often lead to federal criminal charges with concerning consequences.
Being able to recognize practices that constitute health care fraud can help professionals avoid mistakes that could lead to their criminal prosecution. Responding assertively to allegations of breaking the law can be beneficial for professionals who want to protect their licenses and their professional reputations.
