Please enable JavaScript.
Coggle requires JavaScript to display documents.
Health care Fraud - Coggle Diagram
Health care Fraud
Fraud by the Patient
Multiple claims
Misrepresentations on applications
Fictitious claims
Third-party fraud
Inflated Billing Schemes
Added services
Code manipulation schemes
Unbundling
Upcoding
Altered claims
Date of Service
Name of Patient
Amounts
Fraud by Insurance Companies
Failure to pay legitimate claims
Charging unapproved rates
Failure to investigate questionable claims
Requesting rate increases based on fraudulent data
Submission of false documents
Failure to apply discounts
Provider Fraud
Parties:- Practitioners, medical suppliers, and
medical institutions
Type
Fictitious services
Clinical lab schemes
Fictitious providers
Equipment and supplies schemes
Red Flags
Medical records that have been altered
An unusually high volume of patients
Lack of supporting documentation for claims
An unusually large number of claims for reimbursement
Pressure for rapid processing of bills or claims
Unusually high profits compared to similar businesses in the same geographic region
Threats of legal action for delay in making payments