Healthcare Fraud in Texas: Know the Warning Signs

 Posted on September 12, 2023 in Uncategorized

Healthcare fraud costs Texans millions annually through improper Medicaid/Medicare claims, inflated costs, kickbacks, and other schemes that exploit health programs. Learning to identify the red flags of medical fraud can help expose the truth and reduce losses. If you think you are involved with fraud, a healthcare fraud lawyer can help you with the next steps to address the issue.

Billing for Services Never Performed

One of the clearest signs of healthcare fraud is being billed for care you never received. This includes charges for missed appointments you canceled, forged signatures on sign-in sheets, and invoices listing diagnostic tests that were never ordered or completed. Review bills closely and watch for providers billing your insurance for appointments that were canceled ahead of time, as these bogus charges are frequently a sign of fraudulent billing practices. You should also be suspicious if you start receiving bills for medical services that have no explanation or that you have zero recollection of ever receiving.

Upcoded Medical Bills

When a healthcare provider knowingly assigns the wrong service code to inflate costs, it is called upcoding fraud. Watch for charges that seem excessive given the basic or routine care received. Upcoding medical bills is illegal. Scrutinize any bill that seems to charge unusually high fees for straightforward, everyday medical services to check for fraudulent upcoding cheating you and your insurer. This specific type of fraud is more common than you may think.

Offering Free Items in Exchange for Healthcare Business

Under Texas anti-kickback laws, providers cannot compensate patients for selecting their services through free gifts, vacations, or other perks. Report any incentives tied to healthcare business referrals. If a doctor, dentist, pharmacy, or other provider offers you free devices, gift cards, vacations, or other giveaways in exchange for your continued business, it could be an illegal kickback scheme.

Misrepresenting Non-Covered Treatments as Medically Necessary

If a provider bills your insurer claiming a service was medically required when it clearly was not, that likely constitutes insurance fraud. Cosmetic procedures wrongly passed off as reconstructive care is one example. Carefully review any denials from your health insurance provider rejecting coverage for treatments your doctor claimed were medically necessary to spot potential misrepresentation.

Falsifying a Medical Diagnosis to Qualify for Coverage

Lying about a patient’s condition to make them seem eligible for treatments covered by insurance is a fraudulent practice. Falsely diagnosing minor conditions as more severe is a common tactic. Be suspicious if a new doctor immediately provides an unexpected dire diagnosis without performing comprehensive testing, as they may be exaggerating to qualify you for coverage.

Padding Bills with Excess Charges

Some corrupt providers tack on extra charges hoping overburdened insurance processors will simply pay inflated claims. Scrutinize bills for duplicate charges, inflated fees, and add-ons unrelated to your care. Watch for identical tests charged multiple times on the same visit or fees for medical supplies far exceeding retail prices as signs of padding. This is often seen in some hospitals. They will charge you excess for supplies. You should always ask to see a itemized bill to avoid this and to catch any issues.

Contact a Dallas Healthcare Fraud Lawyer

If you or a loved on suspects fraud with your medical professional, a Texas healthcare fraud attorney can help you determine the best approach to move forward. Contact Spencer & Associates at 214-385-8500 for a free consultation.