Dr. Paul Hollern on What Constitutes Health Insurance Fraud

Dr. Paul Hollern supports teaching of proper health insurance billing and coding to prevent chiropractic health insurance fraud

There can be many accusations of insurance fraud. By far the most are not accurate or true and only scare chiropractors.

The two main categories of health insurance fraud are:

  1. Billing for services not performed
  2. Billing for patients not seen.

Bad documentation does not constitute health insurance fraud, just bad documentation.

Outside of the two obvious examples given, health insurance fraud is an pattern of deception.

Occasional mistakes do not qualifiy as a pattern of deception.

Almost every time a chiropractor asks me about health insurance fraud, they have been scared by a collegue or the state organization.

Intent to deceive with a pattern can certainly be considered fraud as well as billing for services not performed and billing for patients not seen.

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