Scroll Top
Bothwell Law Group 304 Macy Dr, Roswell, GA 30076
medicare billing fraud


Medicare billing fraud cases cost the government $60 billion a year, and the problem continues to grow. Abuse is rampant despite more restrictions on healthcare for seniors than ever before. As more doctors hear about fraud convictions and million-dollar fines, more providers are refusing to provide services to patients on Medicare. Some even refuse referrals. This is just one way Medicare fraud impacts people in real ways and why we need to put a stop to it.


There are several reasons billing fraud is on the rise. Some doctors say it’s easy to make billing errors given the complicated medical coding currently in use. Most fraud is really an accident. It seems like a reasonable explanation. Unfortunately, it doesn’t really address the most common fraudulent charges cropping up in today’s investigations.

There are clinics, care facilities, home-based healthcare workers, and others that aren’t just charging people for the wrong services. They’re charging for services never rendered for patients they haven’t seen. They’re splitting visits up and claiming each step in treatment occurred on a different day. That gives the office the ability to add additional office or exam fees. In some cases, doctors are charging patients who simply don’t exist.


Unfortunately, it’s impacting what legitimate healthcare providers are doing. According to the Association of American Physicians and Surgeons, 71 percent of doctors restricted the services they offer. That’s because they’re afraid of triggering investigations. Another 23 percent won’t take on new Medicare patients at all.

Many times, it’s not the doctors or the facilities who are perpetrating the fraud. The latest wave of Medicaid billing deceptions come by way of shady medical supply companies who steal doctor’s licensing information and use it to forge subscriptions for expensive medical devices.


Another hotbed of fraudulent billing activity occurs in the growing hospice industry. Payments made for end-of-life care increased by 81 percent over the last decade. In 2016, it accounted for $16.7 billion of Medicare payouts. Officials estimate 10 percent of those payments were illegal disbursements. Scam artists have made a new industry of Medicare fraud, starting with the patients and families who are the most vulnerable.

The National Hospice and Palliative Care Organization blames extraordinary hurdles in coding for the fact so many hospice organizations are mistakenly bilking the system. The most common issue? Centers charging patients for “general inpatient care” when they receive their services in their homes. The difference is not only obvious, but it results in a reimbursement difference of over $500 per day.

It’s heartbreaking to know that even with rampant billing fraud within the Hospice community, patients overwhelming receive substandard care. A review by the Inspector General at the Department of Health and Human Services (HHS) found 85 percent of patients were not receiving the level of medical care determined necessary by their treatment plans.

The reason Medicare fraud is growing is simply that the system makes it so easy. Patients don’t see their bills before they before the insurance company pays for services. Confusing medical billing impacts whether they’re able to assess what the statements mean once they arrive. And for those in inpatient programs, reporting Medicare fraud can come at an exceedingly high price.


Who can help stop medical billing fraud?

  • Patients
  • Family members
  • Healthcare workers
  • Office staff

Patients and their family members need to be diligent when reviewing Medicare statements in order to detect any errors. When discovered, contact the healthcare provider and ask for a correction. If you’re treated poorly or given the run-around, it might be time to take extra steps to protect your loved one’s benefits.

Healthcare workers and office staff can also help prevent fraud from hurting their patients. Remember, some services have limited coverage. If someone is incorrectly billed for a service or a piece of medical equipment, they won’t receive that coverage again. Speaking up preserves your ability to give patients the care they need and preserves your ability to earn an income.


Under U.S. law, any person can sue a business or individual who is defrauding the government. You represent the nation and share a portion of the reward or settlement. Whistleblowers calling out Medicare fraud received millions of dollars, and they’ve helped stop companies from preying on the sick and elderly.

There’s a certain way you have to make the complaint in order to be eligible to receive any funds, so make sure you take your concerns to a lawyer who is familiar with Medicare fraud litigation.

Contact the skilled Medicare fraud attorneys at Bothwell Law Group by clicking or calling 770.643.1606 today.