According to the Florida Department of Elder Affairs and the Florida SHINE program, an estimated 10% of all money spent on health care in 2018 was lost to some form of abuse, waste or fraud.
Statistics like this make it important for people to be aware of the signs of potential fraud. However, they must also remain open to the difference between honest mistakes and conscious fraud or illegal activities.
Understanding Medicare fraud allegations
A report in the Miami Herald explains that fraud involving Medicare may take a couple of forms. In some cases, it may involve a health care provider submitting a bill to Medicare for reimbursement for a service other than the service provided to the patient with the service billed for offering a higher payment to the provider than the actual service.
Another form of alleged Medicare fraud involves a health care provider billing Medicare for a service not rendered at all.
Recordkeeping and reviews important
Medicare.gov encourages consumers to carefully review any bills or statements they receive from their health care providers and from Medicare. Equally important is for any health care provider to review all documents. Many facilities or even individual practitioners outsource their health care billing to third parties due in part to the complexity involved in these matters.
Errors may occur via the outsourced billing service that could open the door to serious problems for doctors, hospitals and other providers. Early identification of any mistake in the medical billing process may be a valuable means of preventing bigger problems down the road for all parties.