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Have You Been a Victim of Medicare Fraud?

Just like with other types of insurance related entities, fraud can – and does – exist with Medicare, and unfortunately, it can come in a wide variety of forms. Medicare fraud is considered to be either an “intentional deception or a misrepresentation that an individual knows to be false, yet makes anyway, knowing that the deception could result in the receipt of an unauthorized payment to them from Medicare.”

medicare fraudIt has been estimated that over the past 15 years, Medicare fraud has cost the program in excess of $200 billion. Therefore, it is important for both Medicare enrollees and providers to be aware of what constitutes Medicare fraud, as well as to stop such actions should they encounter what appears to be fraudulent actions.

Detecting and Reporting Medicare Fraud

While there are numerous acts that have fraudulently obtained funds from the Medicare program, some of the most common of these include:

  • Medical providers who intentionally bill Medicare for services that are not typically covered
  • Medical providers and facilities that bill Medicare or a Medicare supplement for services that have not actually been performed
  • The receipt of bribes and/or kickbacks
  • The commitment of forgery in order to obtain benefits

Although it may appear difficult to detect, there are ways that consumers can help in detecting Medicare fraud. For example, certain “red flags” may be present if a medical provider states any of the following to you regarding your equipment or services:

  • The services and / or the medical equipment is free
  • The testing is free, however, the provider of the service will require your Medicare ID number for their records
  • Medicare is requiring you to obtain the service or item
  • You will receive a “quantity discount” (i.e., the more tests that you have done, the less costly each test will be)

In addition, you may also be dealing with a provider that is committing Medicare fraud if they are engaging in any of the following:

  • Advertisements for “free consultations” for Medicare enrollees
  • Routinely waiving of copayments without checking your ability to pay for services
  • Claiming that they represent Medicare directly
  • Using high pressure or “scare” tactics in order to sell you costly medical services or testing procedures
  • Billing Medicare for services that you did not actually receive

How to Help Stop Medicare Fraud

If you do happen to find yourself in any of the above situations, there are ways that you can help in stopping Medicare fraud, as well as remove yourself from the situation. First, it is important that you do not give any potentially fraudulent provider your Medicare ID number. This, as well as access to your medical records, should only be provided to your doctor or other legitimate Medicare provider.

In addition, should any medical provider other than your regular physician determine that you need additional testing or procedures, you should first contact your primary health care provider in order to ensure that both professionals are in sync. This way, if something does not appear to be right, you can avoid a potentially bad situation before it has the chance to happen.

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