Learn How to Report Medicare Fraud and Abuse

When it comes to learning how to report Medicare fraud and abuse there are a few things you should know.

Medicare fraud and abuse have become major problems in the healthcare industry. The cost of Medicare fraud to consumers and the government is significant. According to a report by the Department of Health and Human Services, improper payments to Medicare providers in 2020 totaled $28.91 billion.

Keep in mind not all improper payments are due to fraud, but fraudulent activities do account for a significant portion of these payments.

In addition to the financial cost, Medicare fraud can have a negative impact on patient care and outcomes. Patients may receive unnecessary or harmful treatments, and their personal information may be compromised.

Different Types of Medicare Fraud

Medicare fraud refers to illegal activities that aim to defraud the Medicare program, such as submitting false claims, overbilling, or accepting kickbacks.

Following are ten common types of Medicare fraud:

  1. Billing for services not rendered: often claims are submitted for a service that was not provided to the patient.
  2. Upcoding: billing for a more expensive service than the one the patient received.
  3. Unbundling: billing for each component of a service individually, instead of as a package, to increase reimbursement.
  4. Double-billing: submitting two claims for the same service or item.
  5. False certifications: providing false information to obtain Medicare certification, such as falsifying credentials or experience.
  6. Phantom billing: billing for services that were not medically necessary or were not provided at all.
  7. Kickbacks: accepting money or gifts in exchange for referring patients to certain healthcare providers.
  8. Prescription drug fraud: submitting claims for drugs that were not prescribed or not needed by the patient.
  9. Identity theft: stealing a patient’s identity to submit false claims or obtain medical equipment or services.
  10. False diagnosis: billing for a more serious diagnosis than the one the patient actually has in order to receive a higher reimbursement.

The government and healthcare industry are actively working to prevent Medicare fraud. Some of their actions include conducting more audits and investigations, imposing stricter penalties, and increasing awareness and education for patients and providers.

What You Can Do to Fight Medicare Fraud

To combat Medicare fraud and abuse, first you must know how to report medicare fraud and abuse. Report suspect Medicare fraud activity to the appropriate agency or law enforcement office if you suspect illegal or dishonest behavior.

Don’t hesitate to contact the government program’s helpline as soon as possible. Provide them with as much information as possible about the offending individual or organization so they can determine if there is indeed a problem. By doing this, you can help prevent further waste and injustice in the health care system.

Another way you can help combat Medicare fraud and abuse is by being proactive about your own health care. Knowledgable patients are better equipped to protect themselves from scams and errors that could result in fraudulent activity.

Make sure you understand the services you receive, their costs, and any medical procedures or medications prescribed by your doctor. Double-check bills and receipts for accuracy and report any suspicious charges immediately. Protect your identity and never give out personal information over the phone or online to unknown sources.

It’s important to remember that fighting Medicare fraud and abuse is a responsibility we all share. Together we can maintain the integrity of our healthcare system and fight fraud by submitting reports and collaborating with law enforcement agencies.

Who Should You Contact About Medicare Fraud

Organizations like the Medicaid Integrity Patrol exist to offer protection against deceptive practices, while attorneys specializing in healthcare can assist in prosecuting offenders.

At Geldin Insurance, our focus is providing medicare education and coverage to those in need. As a family owned and operated business we’ve been providing great service for over 20 years to California residents.

Together, we can work towards a healthier and more honest future for ourselves and generations to come.

If you have questions we have answers. Let us help you get the coverage you need.

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