THE MANY FACES OF FRAUD

Qatar Today - - COVER STORY -

“Fraud in health­care can take mul­ti­ple di­men­sions. At the sim­plest level, it's when you pre­tend to be pro­vid­ing ser­vices while you are not. It's an ex­treme case, and not very preva­lent. An­other fraud is when you sub­sti­tute a pa­tient who is cov­ered with some­one who isn't. The most com­mon type of fraud is, how­ever, cod­ing up or su­per cod­ing. It's when you do a cer­tain pro­ce­dure that has a cer­tain billing cost but you use a sim­i­lar code fac­tor that pays more. For ex­am­ple, you are ad­mit­ted at a hos­pi­tal for a nor­mal ap­pen­dici­tis pro­ce­dure, but the provider bills your in­sur­ance for a se­vere or in­fected ap­pen­dici­tis and hence gets paid more. This is par­tic­u­larly hard to de­tect be­cause you need some­one present at time of pro­ce­dure to ob­serve this.” - Bi­tar

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