Health insurance fraud usually either involves a medical practice inappropriately billing health insurance or a patient lying about the care they need or have received for personal benefit. Although many people focus a lot of their concerns about enforcement on patient fraud, provider fraud can cost substantially more money. It can also implicate more people than patient fraud, which may only involve the one person receiving benefits inappropriately.
Obviously, a doctor could commit health insurance fraud by billing for procedures that they didn’t perform or even making up completely false patient files. It’s important to realize that as someone working in a medical office, you could also wind up implicated in an insurance fraud scheme.
Billing professionals and other support staff could contribute to fraud
If your job involves transcribing medical records or submitting billing claims to insurance companies, then you could be at risk if the provider that you work for is charged with fraud.
While you may not have personally altered the records, you may be aware that the doctor has you input different billing data than the actual services they provide or that they unbundle or upgrade charges when they enter their notes about the services they provided. Anyone who is aware of intentional misrepresentation in insurance building and participates in it anyway could find themselves implicated in any criminal proceedings that result even if they didn’t personally make money off the fraud.
Learning more about what might lead to fraud charges could help you better protect yourself from allegations against your employer and you as their employee.