Insurance Fraud is a Felony

19 The most common types of fraud committed by dishonest providers include: • Billing for services that were never rendered -- either by using genuine patient information, sometimes obtained through identity theft, to fabricate entire claims or by padding claims with charges for procedures or services that did not take place. • Billing for more expensive services or procedures than were actually provided or performed, commonly known as “upcoding”. • Performing medically unnecessary services solely for the purpose of generating insurance payments. • Misrepresenting non-covered treatments as medically necessary covered treatments for purposes of obtaining insurance payments - widely seen in cosmetic-surgery schemes in which non-covered cosmetic procedures such as “nose jobs” are billed to insurance companies as medically necessary. • Falsifying a patient’s diagnosis to justify tests, surgeries or other procedures that are not medically necessary. • Unbundling - billing each step of a procedure as if it were a separate procedure. • Billing a patient more than the co-pay amount for services that were pre-paid or paid in full by the benefit plan under the terms of a managed care contract. • Accepting kickbacks for patient referrals. • Waiving patient co-pays or deductibles and over-billing the insurance carrier or benefit plan.