As a physician, you signed an oath to do no harm. Therefore, you probably can’t imagine committing a crime—any crime. But can you commit something like fraud through ignorance? Possibly. It is more likely that fraud is an intentional act, but a doctor who, say, only bills for one patient while treating two individuals during the same appointment is guilty of fraud. While that doctor might actually be trying to save the family money, it’s not legal. This example may seem relatively innocuous, but government programs like Medicaid suffer billions of dollars in losses every year due to fraud from individuals who take advantage of the system.
What is Medicaid?
Medicaid is an American program which provides public health care insurance to low-income families who meet certain income criteria. The coverage varies state to state, as the program is funded at both the state and federal level.
Each year, fraud diverts billions of dollars that could otherwise fund legitimate services to lower-income individuals and families who need healthcare. It’s a sad truth. What does fraud look like when it happens?
Common scenarios of Medicaid fraud committed by healthcare professionals
- False billing for services that were not provided
- Performing unnecessary tests or providing unnecessary referrals
- Charging separate fees for services that should be billed as a package
As a doctor, you have a responsibility to not only do no harm but also to practice ethical business. If you do not, the consequences could include loss of your license—and your livelihood.