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.”
It 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.
While there are numerous acts that have fraudulently obtained funds from the Medicare program, some of the most common of these include:
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:
In addition, you may also be dealing with a provider that is committing Medicare fraud if they are engaging in any of the following:
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.