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Three seemingly unrelated imaging providers based in FL were identified in a self-funded employer’s medical claims for what was later verified as phantom billing.
The utilization patterns seen in paid claims history for an employee and his wife indicated a strong probability of “phantom” billing – billing for services never performed. Phantom billing typically involves setting up fake corporation(s) with the intent of billing non-rendered services. The individuals involved with the phantom corporations will then recruit patients by offering them an incentive in exchange for allowing their insurance to be billed.
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Patients will also be offered incentives to recruit other members of the same insurance plan. Phantom providers start and stop billing within a short period of time in order to avoid detection.