Health Care Fraud Schemes To Defraud Medicare

Gavel on money

Recent news agencies in the Chicago areas have reported that area physicians and health clinic owners are among defendants charged in health care fraud schemes to defraud the Medicare program and/or private health insurers of millions of dollars. The Medicare Fraud Strike Force, operating in major cities, has charged more than 85 defendants, including doctors, nurses, and other licensed medical professionals, for their alleged participation in Medicare fraud schemes.

Medicare fraud is a frequent topic in almost every media but most people have no idea what it is or the role they can play in stemming the almost $50 billion dollars that improper payments cost taxpayers every year.

Most Medicare fraud occurs when doctors, hospitals and other health care providers bill for non-existent patients, false diagnoses, unnecessary tests or services that were not provided. In addition, billing errors and improperly coded services add to the dollars that are incorrectly spent. Additionally, many of these same health care providers also violate the anti-kickback statute by offering, paying, soliciting, or receiving payments in exchange for referrals of Medicare patients. The charges most often involve medical treatments and services, as well as durable medical equipment such as home health care equipment.

While Medicare provides necessary and much needed access to health care for more than 48 million Americans, The Government Accountability Office (GAO) has identified Medicare as a high-risk federal program because it is vulnerable to waste, fraud and abuse. The majority of the beneficiaries of Medicare are over age 65 or are younger people with permanent disabilities.

Government officials and legislators continue to look for new methods of containing and eliminating opportunities for fraud. Decentralization of payments makes health care fraud easier to detect as officials can often see localized patterns or sequences of claims made by a particular provider that triggers additional attention by authorities. There is also a need to provide more oversight to Medicare databases to ensure that provider information is accurate and up to date in order to more easily identify trends in fraud, waste and abuse. Another program, currently being carried out by New Jersey, attempts to prevent individuals who have previously engaged in fraudulent practices from collecting Medicaid in the first place.

As a consumer, you should carefully review your bills from hospitals and doctors. If a bill indicates services or tests that you neither requested nor received, ask your health care provider to explain the charges. Make sure that you safeguard your medical information and to avoid people who offer incentives in order to become your health care provider. Treat your insurance cards and numbers in the manner you protect your credit card information. If you suspect Medicare fraud, call the Federal tip line at 800-447-8477.