There are tens of thousands of medical facilities billing both federal and state government insurance programs every day. Most of the employees that work for these insurance programs simply help to process claims. Although there are some professionals whose focus is fraud detection and prevention, they can’t reasonably monitor even a significant fraction of the incoming daily claims.
Some medical practitioners might gamble on the chance that unusual or fraudulent claims will go unnoticed. What these professionals fail to consider is that their patients can actually be the ones who discover major cases of Medicaid (Medi-Cal) or Medicare billing fraud.
Taxpayers all over the country contribute to the funds that support Medicare and Medicaid. When health care providers intentionally over-bill these insurance programs, taxpayers are the ones who pay for those unnecessary charges.
Appointments that never happen, upgraded charges to more expensive procedures or unbundled discounted services represent a significant amount of the insurance fraud that actually occurs every year.
Like private health insurance companies, government insurance programs often send letters explaining benefits and the breakdown of what they recently paid. If a patient who did not attend an appointment receives such a notice, they may report the billing discrepancy as a potential sign of fraud to the Medical Board of California.
Those facing such accusations have the right to defend themselves in court against allegations of billing fraud. They also have the right to defend their professional license.