Health insurance programs, including those administered by the federal government, pay providers based on the services they provide to patients. They rely on the providers to give the patients proper care, and they also rely heavily on proper billing. Unfortunately, there are times when providers don’t handle billing in the proper manner.
Doctors don’t usually handle billing themselves, but it’s critical that they provide the professionals handling the billing with an accurate account of what they did to the patient. One serious issue that can occur is phantom billing.
What is phantom billing?
Phantom billing occurs when the provider charges for medical services or procedures that the patient never had. It’s a form of healthcare fraud that costs insurance companies and the federal government billions each year. Unlike simple billing errors, phantom billing is intentional, as well as unethical and illegal.
Phantom billing isn’t limited only to doctors’ offices. It can also occur in nursing homes, clinics, hospitals and on telehealth platforms. With each incorrect entry, a patient’s health is at risk because of false entries in their medical records, and the cost of medical care increases for other people because of the costs of the phantom billing.
It’s possible to face criminal charges for phantom billing. Anyone who’s facing this type of charge should understand their defense strategy options. These cases can become complex, partially because they usually involve many patients and cases. It may be beneficial to work with someone familiar with these matters so they can assist with determining what options are available to address the specific points in the case against the defendant.