Health care fraud is most often committed by providers, medical billers, insurance companies, and even the individual patient. The most common forms of fraud include billing for services that were not performed, arranging inappropriate testing, utilizing another person’s insurance, and denying valid claims. As you have mentioned, a portion of the uncovered fraud can also be unintentional as those performing the fraudulent act may be unaware of the appropriate restrictions and guidelines. Nonetheless, the Federal Bureau of Investigation (FBI) estimates that fraudulent billings to public and private health care programs are 3–10 percent of total health spending, or $75–$250 billion in fiscal year 2009 (CITE). In order to reduce intentional as
