Provided below is a list of the most common or frequent types of provider fraud:
Billing for Unnecessary Services or Items: Intentionally billing for medical services or items that are not necessary.
Billing for Services or Items Not Provided: Intentionally billing for services or items never provided.
Unbundling: Billing for multiple codes for a group of procedures covered in a global code
Upcoding: Billing a higher cost code than than the service that was actually provided
Card Sharing: Knowingly treating and claiming reimbursement for someone other than the eligible patient.
Collusion: Collaborating with patients to file false claims for reimbursement
Drug Diversion: Writing unnecessary prescriptions, or altering prescriptions, to obtain drugs for personal use or to sell them
Kickbacks: Offering or receiving payments for patient referrals for medical services or items”
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