Urgent care centers are convenient and essential healthcare providers for many individuals. Patients place their trust in these facilities and expect them to provide accurate, professional, and necessary services. However, urgent care fraud is a growing issue, and it’s crucial to understand how to recognize and report it.
This article will provide a comprehensive guide on what urgent care fraud is, how to identify common red flags, and the steps to take if you suspect fraudulent activity.
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What is Urgent Care Fraud?
Urgent care fraud is a form of healthcare fraud involving deceptive practices within urgent care centers. These practices can result in financial loss for patients, insurance companies, and the healthcare system as a whole.
Fraudulent activity can occur in various ways, including overcharging for services, billing for services not provided, or providing unnecessary treatments/tests.
It’s essential to understand the different types of healthcare fraud to recognize and prevent urgent care fraud specifically.
Common Examples of Urgent Care Fraud
There are numerous ways in which urgent care fraud can occur. Some common examples include:
- Unnecessary medical services and testing: Some urgent care centers may recommend and provide services or tests that are not medically necessary in order to increase their revenue. This type of fraud can lead to inflated bills and potential harm to patients who undergo such services and procedures unnecessarily.
- Billing for services not provided: In some cases, an urgent care center may bill for services that were never rendered.
- Duplicate billing: Fraudulent urgent care centers may submit multiple claims for the same service, effectively charging both the patient and the insurance company for the same medical services.
- Upcoding or unbundling of services: Upcoding occurs when a provider bills for a more expensive service than the one actually provided. Unbundling is the practice of billing separately for services that should be combined into one charge, resulting in higher costs for patients and insurers.
- Kickbacks or illegal referral schemes: Some urgent care centers may participate in kickback schemes, where they receive financial incentives for referring patients to specific providers, labs, or medical equipment companies.
Providers, nurses, billers, and other urgent care staff members may become aware of these frauds by urgent centers as they face pressure to satisfy the profit-driven demands of their employers. For example, attorney Jeff Newman recently represented a former employee of CareWell Urgent Centers in a False Claims Act lawsuit where CareWell paid $2 million to resolve allegations that it required its clinicians to conduct, and bill for, unnecessary examinations of body systems that were unrelated to the patients’ health complaints or symptoms.
Similarly, in 2020, UCXtra Umbrella, the owner of an Arizona-based chain of urgent care centers, was ordered to pay $12.5 million after it was convicted of causing its health care providers and staff to overstate the complexity of the medical services performed, and of encouraging providers and staff to order tests and procedures that may not have been medically necessary.
How to Recognize Urgent Care Fraud
Recognizing urgent care fraud can be challenging, but being aware of some common red flags can help you recognize potentially fraudulent activity:
- Inconsistencies in medical records: Ensure the treatment provided matches the medical services billed and be alert for any discrepancies.
- High-pressure sales tactics: Be wary of aggressive tactics to convince patients to undergo additional procedures or tests that may not be medically necessary.
- Red flags in billing: Be aware of unfamiliar charges, duplicate billing, or charges for services the patient did not receive.
- Provider behavior: Be on the lookout for ordering numerous tests, prescribe medications, or recommend additional treatments, without a clear medical justification.
Report Urgent Care Fraud
If you suspect that your employer is committing urgent care fraud, it’s important to report it as soon as possible. By doing so, you can help prevent fraud against federal healthcare programs, such as Medicare and Medicaid, and ensure that primary and urgent care centers deliver high-quality health care and treatment services to their patients.
We offer free and confidential consultations. If you are aware of urgent care fraud, contact us today to learn more about the False Claims Act and the potential to receive a whistleblower award.