By Theodore Keowaller
The Medicare program is a federally-funded medical plan for Americans age 65 and above that covers medical expenses such as clinic visits, hospital admissions, medications and other treatments. However, this program has been a target for fraud probably because it has few safeguards to weed out false claims.
There are different schemes involved in Medicare fraud, and one of them is phantom billing. In this scheme the healthcare provider bills Medicare for procedures and tests that were never performed or a supplier that bills for durable medical equipment that were never used or delivered. Tactics like upcoding and unbundling are also quite prevalent. Upcoding is the practice wherein the insurer, in this case Medicare, is billed for a service with a higher CPT code than what was actually performed, resulting in higher reimbursement.
Unbundling is the practice of breaking down services like blood and chemistry panels into individual components, resulting in a higher payment by Medicare. Identity theft is also a known Medicare fraud tactic which occurs when someone steals your personal information, in this case your Medicare information, to obtain medical care, buy drugs, or submit fake billings using your name.
This fraudulent activities milk the Medicare system of billions of dollars per year, and this contributes significantly to the increasing cost of health care. This is why it is important to report Medicare fraud. To spot Medicare fraud, you have to make it a habit to record the dates and save receipts and statements you get from providers every time you get healthcare services. Compare these against your Medicare summary notice and check for entries that are erroneous. If you find any billing errors, call the provider or supplier first, so they will be notified about it and make necessary corrections. If you can't reach the provider or you are still being charged for a service or supply you didn't get, call 1-800-MEDICARE. The sooner you see and report these fraudulent activities, the sooner Medicare can stop it.
Also, protect your Medicare number. Be leery of people who offer you free medical equipment or services and then requests your Medicare number. Remember, if it's free, why do they need your number? Also, don't let anyone borrow or pay to use your Medicare ID.
There are different schemes involved in Medicare fraud, and one of them is phantom billing. In this scheme the healthcare provider bills Medicare for procedures and tests that were never performed or a supplier that bills for durable medical equipment that were never used or delivered. Tactics like upcoding and unbundling are also quite prevalent. Upcoding is the practice wherein the insurer, in this case Medicare, is billed for a service with a higher CPT code than what was actually performed, resulting in higher reimbursement.
Unbundling is the practice of breaking down services like blood and chemistry panels into individual components, resulting in a higher payment by Medicare. Identity theft is also a known Medicare fraud tactic which occurs when someone steals your personal information, in this case your Medicare information, to obtain medical care, buy drugs, or submit fake billings using your name.
This fraudulent activities milk the Medicare system of billions of dollars per year, and this contributes significantly to the increasing cost of health care. This is why it is important to report Medicare fraud. To spot Medicare fraud, you have to make it a habit to record the dates and save receipts and statements you get from providers every time you get healthcare services. Compare these against your Medicare summary notice and check for entries that are erroneous. If you find any billing errors, call the provider or supplier first, so they will be notified about it and make necessary corrections. If you can't reach the provider or you are still being charged for a service or supply you didn't get, call 1-800-MEDICARE. The sooner you see and report these fraudulent activities, the sooner Medicare can stop it.
Also, protect your Medicare number. Be leery of people who offer you free medical equipment or services and then requests your Medicare number. Remember, if it's free, why do they need your number? Also, don't let anyone borrow or pay to use your Medicare ID.
About the Author:
Aside from ripping off taxpayers and beneficiaries, Medicare fraud also contributes greatly to rising cost of healthcare. Click here to know where to report Medicare fraud. Click here for more information on report medicare fraud
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