Medical Billing Fraud A Concern For W.Va. U.S. Attorney’s Office

Health care fraud was the topic of a forum held by WVU’s Law School and the U.S. Attorney’s office Thursday.

Examples of this fraud are when doctors or clinics bill a patient incorrectly or perform unnecessary procedures. This costs consumers, insurance companies and government insurance programs like Medicaid and Medicare.

“It could be something as simple as being billed for a procedure that didn’t actually occur, it could be something where you are billed for a higher code than was appropriate, you might be billed for an extended office visit, when you are actually only there for a couple of minutes,” said U.S. Attorney William Ihlenfeld.

Consumer protection and health care representatives from both the public and private sectors shared what they know about medical fraud Thursday in Morgantown. That included representatives from both the West Virginia Medicaid Fraud Unit, the U.S. Department of Health and Human Services Office of Inspector General and insurance companies.

Ihlenfeld said his office is spending “a tremendous amount of time on these cases” that he hopes to bring forward this year. He said with an influx of government funding during the COVID-19 pandemic, he is building cases on how medical providers in West Virginia may have performed unnecessary testing or procedures for profit.

“As they say, ‘no one lets a good crisis go to waste.’ And unfortunately, we have some people who have taken advantage of that situation in order to profit from it,” Ihlenfeld said.

The U.S. Department of Justice recently charged two people in California for allegedly billing health agencies for unnecessary COVID-19 testing in the amount of $144 million. 

“There’s billions of dollars every year in America worth of healthcare fraud. West Virginia certainly sees millions of dollars of fraud every year,” Ihlenfeld said.

Reports can be made to the U.S. Attorney’s Office or the U.S. Department of Health and Human Services.

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Charleston Area Medical Center and Marshall Health.