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What is phantom billing in a health care setting?

On Behalf of | Jul 11, 2022 | Criminal Defense

Given the way the media frames the issue, it is not surprising how many people think of individuals receiving benefits that they don’t deserve when they think about health care fraud. The media has long talked about people who under-report their income or lie about their citizenship to take advantage of government medical insurance programs.

However, patient fraud represents only a tiny fraction of the healthcare fraud that occurs every year. Fraud by care providers can be far more expensive and common. Phantom billing is one of the more common forms of healthcare provider insurance fraud, and it could be an issue at the health care facility where you work.

What constitutes phantom billing in the health care industry?

Phantom billing means charging for services never rendered

As you might be able to figure out from the name, phantom billing involves submitting a bill to insurance companies or even the government for healthcare treatments that never occurred.

Sometimes, there will be expenses passed on to the patient, such as when they have a co-pay or deductible on their policy. Many times, the insurance company is the party that will lose the most because of phantom billing practices. They will pay for care that an individual never received, thereby increasing their operating expenses.

Phantom billing increases how much it costs to provide health insurance and therefore how much it costs for people to maintain their own policies. While there are those who think of such practices as victimless crimes, insurance companies and the federal government will move to prosecute individuals implicated in phantom billing schemes.

Anyone involved in billing could end up facing charges

You might think that as a billing specialist, you don’t have any risk for inputting the codes because you don’t make any money off of those transactions. However, you could easily get caught up in enforcement efforts initiated by an insurance company or by a patient who received a letter about a claim and knew they had never attended an appointment.

Learning about phantom billing and other billing practices that could lead to white-collar criminal charges can help those who work in the medical field avoid mistakes that could cost them their career or maybe even their freedom.


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