When medical providers charge insurance companies for services, visits or supplies that were never received, it’s often referred to as “phantom billing.” It is a major problem.
This type of fraud seriously affects government programs like Medicare and Medicaid. Let’s look more closely at it.
How it works
A health care provider can fabricate medical visits, tests or surgical procedures and then submit claims to Medicare or Medicaid using the information of an existing, legitimate patient. This can happen when a patient visits a doctor for a test, and the doctor bills Medicare or Medicaid for that visit and follow-up visits that never took place.
The doctor may state that the patient visited three times a week per month when, in reality, they visited once. They may add procedures, such as a diagnostic test, that were never provided.
It’s also not uncommon for phantom billing to involve past patients. Health care providers have established medical files and personal data on record. A doctor may use a patient’s Medicare or Medicaid identification number to bill government programs for services they never provided.
A medical equipment supplier or health care provider also engages in phantom billing when they bill Medicaid or Medicare for durable medical equipment (DME) that was never shipped or received by a patient. They may say that the DME was more expensive than it actually was.
How it affects government programs
Phantom billing severely depletes the financial resources of government programs. This can increase the overall cost of health care, reduce coverage and tighten service limits for legitimate patients.
Exposing phantom billing can significantly protect taxpayers. If you work in the private health care sector and have identified discrepancies, get more information on the next steps to take.