As a taxpayer, you play an essential role in funding Medicare, the health insurance program dedicated to providing medical care to senior citizens and individuals with certain disabilities. However, as with any large-scale program, fraudsters often attempt to exploit the system to get gain, affecting its efficiency and integrity.
Understanding examples of Medicare fraud can help you recognize suspicious activities.
Billing for services not provided
One of the most common types of Medicare fraud involves healthcare providers billing for services that they did not actually provide. This can involve anything from falsely claiming to have conducted medical examinations, to billing for procedures or treatments that never occurred.
Unnecessary medical procedures
In some cases, healthcare providers may suggest and perform unnecessary procedures or treatments on patients and then bill Medicare. While this is not only fraudulent, it can also put the health of the patients at risk, as they undergo unnecessary medical procedures.
Overcharging for services or equipment
Some healthcare providers commit Medicare fraud by inflating the costs of their services or medical equipment. They might charge more than the actual cost or bill for more expensive services or equipment than what they actually provided.
Upcoding involves billing for more expensive treatments or procedures than those actually provided. For example, a healthcare provider may bill for a complex procedure when they only performed a simple one.
Kickbacks involve offering, soliciting or accepting payment to get referrals for items or services covered by federal health programs. For instance, a medical device company might offer a kickback to a doctor for recommending its product.
Medicare fraud can also take the form of identity theft. Fraudsters might steal Medicare numbers and other personal information to submit false claims to Medicare.
Sometimes, fraudsters create false patient records or forge physician signatures to make their fraudulent claims appear legitimate.
Recognizing the signs of these fraudulent activities and reporting them can contribute to protecting the integrity of the Medicare system.