Tag Archives: Medicare Fraud

A Briefer On Medicare Fraud

Medicare fraud has long been a problem of the state. The funds allotted for the people are being diverted into the pockets of some selfish individuals. This is why the government is constantly campaigning for citizens to help them stop this through medicare fraud reporting.

The government alone cannot defeat the evils of medicare fraud. The mechanism of how it is committed requires an insider or someone who knows what exactly is happening. So tips from citizens are really very helpful for them.

The prime goal of medicare is to provide better services to the people. The government wishes to provide better healthcare services through a form of health insurance system. This gives people quality medical services for lower prices. But it’s unfortunate that there are still those who are only concerned of filling their pockets.

Medicare fraud reporting is one big step into helping the government stop this scam once and for all. But in order for you to be truly helpful, you need to know how fraud is committed and by whom. Here’s a guide to the anatomy of medicare fraud.

Who commits fraud?

It’s a sad reality that the very people entrusted to implement this government program are also the ones who are involved in this scam. Medical practitioners and medical suppliers are usually the ones involved in these scams.

How is it committed?

There are two major ways of committing medicare fraud namely: tampering bills or faking them. Some of them use the personal information of medicare beneficiaries in order to bill the government of products and services that were not really availed of. Others superimpose or change the bills of some of their patients or clients. Instead of a simple service they change it into a more complicated and expensive one. This makes the government pay more than what the people have actually availed of.

How can you help?

Each one is urged by the government to be vigilant and do their part. if you have any suspicions or knowledge about these operations, you can report them immediately to the medicare fraud hotline.

Medicare Fraud: What You Should Know

Medicare fraud reporting has not been common in the United States nowadays despite many frauds. Medicare fraud is characterized by instances wherein a medical provider tries to cheat the Medicare program through false information for monetary gain.

Some accusations towards providers didn’t have sufficient supporting evidence, thus many frauds go undetected. Many providers, suppliers and physicians take advantage of the “honor system” of billing followed by the Medicare program. In the past, it was meant to assist honest physicians who care for the less fortunate with medical services.

The following types of circumstances necessitate Medicare fraud reporting:

1. Patient Billing – this happens when the patient who also takes part in the fraud will present their Medicare number in order to get kickbacks. The physician, supplier or provider will charge Medicare and the patient will pretend to have received the medical service or item.

2. The provider inflates the bills through a billing code falsely stating that the patient needs to go through an expensive medical procedure.

3. Phantom Billing – this is a scenario wherein the medical supplier, provider or doctor will charge Medicare for excessive services or for services that were never provided for, such as medical tests or equipment. To prevent this, the patient can closely examine the records for any discrepancy.

As a beneficiary of Medicare, the program relies on you as a vital link to detecting Medicare fraud. Only you can really narrow down the services and items that were and were not provided to you. Once you’ve received your Medicare Summary Notice, it is best to thoroughly examine its contents.

If you find anything suspicious, notify the physician, supplier or provider as it might just be an honest mistake. If they do not assist you about it, then you can report them.

The Medicare Fraud hotline is 1-800-HHS-TIPS (1-800-447-8477). You can also contact them by Fax at 1-800-223-2164 (maximum of 10 pages), and email at HHSTips@oig.hhs.gov.

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