The previous account is an example of reimbursement fraud. There are accounts of physicians committing fraud, and yet, the small number of dishonest surgeons is rarely detected. Reimbursement fraud is a scheme used by employees/employers to claim a higher payout when an action or motive did not take place (Wynia, Cummins, VanGeest, & Wilson 2000). This action is against the law, and physician penalties entail: paying high fines, subject to imprisonment, and possibly termination of the practice. Misleading CPT codes are the most efficient way of reimbursement fraud in the medical field. CPT codes are a five digit number that describes medical treatment procedures and aid in billing. Physicians can easily alter cost amounts by changing one number in the CPT code. By acting on this, the physician has not only betrayed the patient, but has committed a crime, and costs insurances companies thousands of dollars.
Reimbursement fraud can be stopped in numerous ways. As a patient, after a procedure demand detailed receipts of what charges have been applied. This receipt will include all procedures that took place, co-payments collected if needed and CPT codes. The CPT codes will not make sense, but as a patient you do have the right to research what the code may interpret. Another way to protect yourself is to inquire about scheduling a conference with the staff that was present during the procedure. In doing so, you as the patient, are reinforcing your questions or concerns with an eyewitness. If you or someone you know may suspect reimbursement fraud please call 1-800-318-2596 (Palmer, 2013).