Medicare fraud occurs when Medicare is billed for services or supplies which its beneficiaries never received. Fraud turns into abuse when health care providers or suppliers do not adhere to ethical medical practices which can lead to unwanted expenses for Medicare. The US Department of Justice reported that Medicare fraud erodes more than 60 billion of taxpayers’ money annually, which makes it, one, if not the most lucrative organized criminal act in the United States.
Although only a small percentage of healthcare providers deliberately manipulate claims, Medicare fraud affects everyone because it contributes greatly to increasing healthcare costs. That means, we and our employers shell out more money to pay for healthcare benefits. Fraudulent practices will also limit the resources and the level of care available to beneficiaries.
Medicare fraud involves various schemes. One tactic which fraudsters use is phantom billing which is submitting claims for products or services that were never delivered or administered. It may also involve unbundling which is the practice of separately charging several tests or procedures that are actually part of a single panel or procedure in order to profit from the price difference. Upcoding is also another scheme used by fraudsters and this involves charging for a much more expensive procedure or test than what was actually administered.
If you are a recipient of Medicare benefits or have a loved one who is, there are things you can do to protect yourself from being victimized by fraudsters. For one, you should protect your Medicare and Social Security numbers with the same vigilance as protecting your banking information. Also, whenever you get healthcare services, you should record the dates and save receipts you get from your doctor and compare these with your Medicare summary notice to see if you were billed for services or items you didn’t get.
Clearly, knowing how to spot fraud is the most essential step to preventing it. If there are discrepancies, first call your healthcare provider. In majority of instances, these discrepancies were not intended and can be corrected without any issues. However, if the doctor or supplier does not return your calls or does not cooperate, you should report Medicare fraud by getting in touch with the Medicare Company that processed the claim. If you want to report Medicare fraud in a confidential manner, you may get in touch with the Office of the Inspector General as well.