Question

Discussion Question #1: The Criminal Health Care Fraud Statute (18 U.S. Code Section 1347) prohibits knowingly and willfully executing, or attempting to execute, a scheme intending to defraud any health care benefit program or obtain (by means of false pretenses, representations, or promises) any of the money or property owned by, or under the custody or control of, any health care benefit program. Of the following practices which constitutes fraud? Are these practices unethical? 1. Billing for services not provided 2. Billing for services not covered under a patient's health insurance 3. Unbundling; that is, billing separately for each stage of a procedure 4. A licensed health care practitioner allows an unlicensed person to bill an insurer under his name 5. A medical facility waives deductibles and copayments

Answer 1

#. The practices which constitutes fraud are :-

- Billing for services not provided

- Billing for services not covered under a patients health insurance

- A licensed healthcare practitioner allows an unlicensed person to bill an insurer under his name

- A medical facility waives deductibles and co-payment

All these are unethical and fraud because these are against the law and ethics