Question

4. At the end of the day, a medical office or hospital needs to collect money for the patient’s visit or stay. In your opinion, when conducting billing activities, what constitutes fraud or abuse? Please provide an example of fraud or abuse committed by a provider. Express your thought about what should be done legally to resolve the matter

Answer 1

It could be overcharging for a service. A patient goes in expecting a service such as a physical to be covered according to their insurance policy. The doctors office insists its not covered. They bill you and have you pay coinsurance or toward a deductible stating its not covered and bill your insurance resulting in a payment from you and your insurance.