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What is Medicare fraud?

On Behalf of | Jun 1, 2022 | White Collar Crime |

You hear a lot about patients trying to commit Medicare fraud, but did you know that some medical professionals are guilty of this as well? People commit Medicare fraud in order to receive payment for something that never happened, or that they are not entitled to.

These are some examples of what constitutes Medicare fraud by a physician or another medical professional.

Having Medicare pay for non-existing services

One example of a healthcare provider attempting to deceive Medicare is billing for services that they never provided to a patient. Because Medicare receives large amounts of paperwork each day, this may go unnoticed for a certain amount of time. However, the truth usually eventually comes out upon an audit or if a Medicare representative speaks to a patient and discovers that the service never happened.

Misdiagnosing a patient

A physician may provide Medicare with an incorrect diagnosis of a patient in order to justify payment of a higher cost of treatment or medication. Often unknowing to the patient, the doctor may pocket the difference of the higher cost of treatment.

Providing unneeded services

Along the same lines as misdiagnosis, a physician may provide services that a patient does not need, but pass them off to Medicare as medically necessary. This is because Medicare will generally not reimburse for procedures that are not medically necessary.

Being aware of the different types of Medicare fraud can help you avoid having a healthcare professional use you and your treatment for their own personal gain, or to make Medicare reimburse for treatments that they would not otherwise.