Automated Split Testing

Various Tactics Used By Fraudsters To Milk Money From Medicare

January 21st, 2012

The Medicare system is the healthcare insurance plan provided by the government for Americans age 65 and over. This provides coverage for healthcare costs like check-ups, hospital stays, meds, equipment, and procedures. 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 involves inflating bills by using diagnosis or procedure billing code to justify why the patient needs expensive treatments or tests.

Unbundling on the other hand involves submitting multiple bills to obtain a higher reimbursement for tests and procedures that should have been submitted as a single bill, which has lower reimbursement. 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 identify Medicare fraud, you have to log the dates when you sought medical services, equipment or goods, and keep the receipts provided by the doctor or the staff at his or her practice, and the suppliers. By comparing these with the claims Medicare processed, you will see if you were billed for services or items you didn’t get. If you find any billing errors, call the provider or supplier first, so they will be notified about it and make necessary corrections. However, if they do not return your calls, or refuses to help you correct those errors; don’t hesitate to contact the Medicare hotline at 1-800-MEDICARE. The earlier you notify Medicare of the problem, the sooner they can address it as well.

Also, protect your Medicare number. Be leery of people who offer you free medical equipment or services and then requests your Medicare number. Always remember, that if they say that they are giving the items or services for free, there is no need to provide your Medicare information. Also, don’t let anyone borrow or pay to use your Medicare ID.

Medicare fraud is rampant and it milks billions of dollars from our health care system. Click here to know where to report Medicare fraud. Click here for more information on report medicare fraud