What is health care fraud?

Health care fraud is a type of consumer fraud that occurs when an individual or business deliberately deceives an insurance company or government agency for financial gain. In Kansas, health care fraud is defined as any intentional act of deception by a provider of healthcare services or an individual on behalf of a provider of healthcare services, to obtain reimbursement or payments to which they are not entitled. Health care fraud may include activities such as billing for services that were not provided, submitting claims for higher amounts than were actually paid, or billing for medically unnecessary services. Health care fraud also includes kickbacks, self-referrals, and upcoding. Self-referrals occur when a provider refers patients to a service they own or have a financial interest in, for instance, a doctor referring a patient to their own clinic. Upcoding is when a provider intentionally changes a code for a service to increase the amount of reimbursement they receive. Finally, kickbacks occur when an individual or business is paid for referring a patient to a certain provider or service. In Kansas, health care fraud is a serious criminal offense. Violators face up to five years in prison and up to a $25,000 fine. If the fraud involves Medicaid or Medicare, the penalty is much greater. Individuals convicted of Medicaid or Medicare fraud in Kansas can face up to ten years in prison and fines up to $25,000.

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What is health care fraud?

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