What are the top 5 types of Medicare fraud?

With the U.S. population continuing to age and approximately 61 million people now enrolled in Medicare, the opportunities for Medicare fraud likewise continue to escalate. If you face Medicare fraud charges, defending against them can quickly become complicated and time-consuming.

Unfortunately, only the minds of actual perpetrators limit the possible types of Medicare fraud. Nevertheless, Coverage.com lists the following as the top 5 types of Medicare fraud today:

1. Billing for unrendered services
2. “Renting out” provider numbers
3. Billing for unprovided or unnecessary medical equipment
4. Receiving kickbacks from fraud “partners”
5. Double billing

1. Billing for unrendered services

Here, health care providers add additional tests, treatments, etc. to those they actually rendered to their patients before they bill Medicare.

2. “Renting out” provider numbers

Here, providers give their provider number to other providers, resulting in multiple claims by multiple providers for the same services to the same patients.

3. Billing for unprovided or unnecessary medical equipment

Durable medical equipment, such as wheelchairs, walkers, crutches, etc., makes up a substantial portion of Medicare reimbursement payments each year. Consequently, unscrupulous providers can make big money by billing for equipment their patients did not need or, alternatively, never received.

4. Receiving kickbacks from fraud “partners”

This type of Medicare fraud requires a group of unscrupulous providers acting in concert. Several “team” members bill Medicare for the same services or equipment and then split the reimbursement proceeds.

5. Double billing

Here, a provider bills both Medicare and the patient’s private insurance company for the same services or equipment.

Your best defense against alleged Medicare fraud consists of keeping meticulous records of which services and equipment you provide to each of your patients, the dates on which you provide them, who and when you bill for them, and the amounts and dates on which you receive Medicare reimbursement.