Things You Should Know About Medicare Fraud
Social insurance programs like Medicare is important because it guarantees healthcare services for Americans ages sixty-five years old and older, and even to younger people who are unable to earn a living due to disabilities. By offering prescription drugs, hospital stays, clinic appointments, procedures and tests at a lower cost, the Medicare program helps keep its recipients from experiencing even more severe financial hardships from managing their health.
The sad thing is that the Medicare program is not immune to fraudulent activities. Fraud is prevalent in the Medicare program because its billing process is based on an honor system. At the same time, the Medicare system puts more emphasis on paying claims smoothly and quickly, and not so much on verifying if the claims are fraudulent. Medicare fraud can take the form of phantom billing where the healthcare provider or supplier bills for services or supplies that were never rendered or delivered.
Unbundling is also another way of defrauding the Medicare program and it involves submitting several bills for tests or procedures that are usually less expensive when performed as a panel or at one time. Another scheme used by fraudsters is upcoding where the provider inflates bills by using billing codes which indicate that the patient experienced medical complications or a more serious condition to justify billing for more expensive treatments. Apart from doctors and suppliers, some beneficiaries can also participate in fraudulent schemes by allowing others to use their Medicare number so they could earn kickbacks.
Even though most of medical service providers are trustworthy, the small percentage of providers that milk Medicare through fraudulent means costs the country about 30 billion dollars per annum. In addition to that, newer cases demonstrate that providers that use these underhanded tactics are increasingly less concerned of the risk they are placing their patients in. We all pay the price because these fraudulent activities contribute significantly to rising healthcare costs.
As a taxpayer or a recipient of such social program, you have to report Medicare fraud. Remember though that prior to reporting fraud you have to contact your provider first to have any errors on your Medicare Summary Notice corrected. More often than not, these mistakes are unintentional and can be quickly rectified. However, if they do not return your calls or do not cooperate, then call 1-800-MEDICARE or write the Medicare Company that paid the claim. You may also report Medicare fraud to the OIG.
Medicare fraud costs taxpayers money, and erodes resources otherwise spent for beneficiaries. It also puts the welfare of the beneficiary at risk. Know how to report medicare fraud by clicking here.
