Rotating Quotes Argus Defines U.S. Healthcare/Medical Billing Fraud – Inflated Medical Costs, Upcoding

Healthcare Fraud

Argus in Action
– Sample U.S. Case Studies –

Health Insurance Claim/Billing:
Two medical claims received for newborn twins admitted to the NICU totaling $91,071.30

Reduced Medical Cost:
A thorough itemization of the hospital bill revealed medical coding errors and duplicate charges so ARGUS Claim Review was able to recover $12,317.32 on the client’s behalf.

>> Save with Argus Claim Review 

What is Healthcare Fraud?

Understanding Healthcare/Medical Billing Fraud
When it comes to healthcare and medical billing fraud in the U.S., there isn’t one simple definition. Unlike the wrong medical code mistakenly entered or other common insurance coding and billing errors, there are several practices that constitute intentional healthcare fraud. Argus Claim Review of the Upper Midwest offers expert claims management services to help identify any case of over-billing for our client from New York to California. Examples include charging too much for supplies on a patient’s hospital bill or adding a treatment that isn’t a medical necessity.

A lack of transparency rules is a huge problem, along with:

  • Inaccurate healthcare billing for services, procedures, and/or supplies that were never provided
  • Misrepresentation of: type of medical services provided or when they were provided, condition or diagnosis used in ICD-9 or CPT medical coding/procedure codes, the identity of the patient
  • Providing unnecessary medical services/treatments or ordering unnecessary tests solely to generate revenue
  • Unbundling of procedures
  • Double billing
  • Medical upcoding
  • Kickbacks
  • Artificially inflating prices