68% Of Health Care Fraud Cases Involve False Billing

About 68% of health care fraud cases resolved in 2010 involved false billing by a provider organization. The most common false billing schemes were billing for services or supplies that were not provided; billing for services not medically necessary; upcoding services to a service with a higher reimbursement rate than the rate for the service actually delivered; billing for services not prescribed or referred by a physician; and billing for services delivered by unqualified, uncertified, unlicensed, or ineligible professionals. The other common types of health care fraud cases involved falsifying records to support the fraud scheme, paying kickbacks to participants . . .