Examples of Medicare fraud

On Behalf of | Feb 14, 2021 | Medicare / Healthcare Fraud

There are many examples of fraud in the healthcare industry. Although some people have a purposeful intention of defrauding an individual or system, sometimes it is unintentional.

Medicare fraud occurs when someone seeks financial gain by using Medicare information illegally. This may include billing discrepancies or the stealing of someone’s Medicare number.

Fraud by healthcare providers

According to Medical News Today, fraud involving healthcare costs the United States billions of dollars every year. Individual medical providers as well as large institutions may take advantage of a patient’s Medicare benefits in a number of ways. Some examples include:

  • Billing for an appointment when the patient was not scheduled or did not show up
  • Billing for different or additional services from what the patients actually received
  • Billing for services that the provider did not do
  • Telling the patient that Medicare will pay for something when it does not
  • Paying for referrals
  • Billing for equipment the patient already returned

Doctors and billing personnel can prevent unintentional fraud by reviewing bills and comparing them to the doctors’ notes to ensure accuracy.

Fraud by other individuals

According to U.S. government site for Medicare, individuals not associated with patient care or a healthcare facility may also commit fraud. Con artists attempt to obtain patients’ Medicare numbers and other personal information for different types of fraud.

Some strategies these fraudsters use include contacting people to enroll them over the phone, visiting people at their homes and promising things in exchange for a Medicare number.

Patients can help identify Medicare fraud by reviewing their statements and reporting any incorrect charges, services or prescriptions and any other suspicious mistakes.