“The overwhelming majority of individuals who work in the healthcare system are honest. However — in the hands of fraud perpetrators, telemarketing techniques — false or altered billing codes, forged documents and computer technology are powerful tools used to illegitimately collect billions of dollars every year from unsuspecting consumers and their health insurers. Some schemes include:

• Phantom billing – Adding otherwise legitimate claim charges for services never performed or fabricating claims.
• Upcoding – Charging for a more expensive service such as a visit to a specialist when the patient actually saw a nurse or an intern.
• Doctor shopping – Bouncing from one doctor to another in order to obtain multiple prescriptions for controlled substances.
• Providing unnecessary care – Including unnecessary tests, surgeries and other procedures.
• Misrepresenting services – Performing uncovered services but billing insurance companies for different services that are covered.
• Unbundling – Charging separately for procedures that are actually part of a single procedure.
• Masquerading as healthcare professionals – Delivering healthcare services without proper licenses.
• Identity theft – Using another person’s health insurance card or identification to obtain healthcare or other services or to impersonate that individual.”