Social insurance programs such as Medicare is very helpful since it ensures that Americans ages 65 and over, younger individuals who are unable to make a living due to physical handicaps or end-stage renal disease are able to access healthcare services. 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.
Unfortunately, the Medicare program has been a prime target for fraudsters. 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. One scheme used in Medicare fraud is phantom billing and this is when a provider submits a claim for services or supplies that are not given.
It can also involve unbundling which is billing for multiple tests or services that are usually much cheaper when done together. Upcoding is also another tactic used by fraudulent providers and this involves submitting a bill for a higher CPT procedure codes than were actually performed, resulting in a higher payment by Medicare. Aside from medical professionals and suppliers, some patients can also defraud the Medicare program, like by giving their Medicare number in exchange for kickbacks.
Although majority of health care providers are honest and well-intentioned, the small number of providers who are intent on abusing the social program costs taxpayers an estimated thirty billion dollars a year. Also, the sad thing is that recent cases show that fraudulent medical professionals are often willing to risk harming the patient just to carry out their schemes. 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. In most instances, these errors are unintended and can be easily corrected. Then again, if they do not answer your calls, avoid talking to you, or refuses to correct the error, you can get in touch with Medicare by writing to them or calling their hotline at 1-800-MEDICARE. If you prefer, you can also report Medicare fraud anonymously to the hotline maintained by the Office of the Inspector General.
Medicare fraud strains Federal and state budgets and contributes significantly to healthcare costs across the country. Recent cases also show that fraudulent providers are willing to risk harming the patient just to carry out their schemes. Follow this link to learn where to medicare fraud.
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- Mitigating Medicare Fraud – Why You Should Participate
- Identifying Medicare Fraud And Learning How To Stop It
- What Social Health Services Are
- Make Big Bucks By Becoming A Whistleblower
- Want To Stop The Bleeding Of Healthcare Services? Read On
