Even if you are highly familiar with Medicare, it may not be easy to spot Medicare billing fraud. Medicare is an insurance program provided by the federal government to individuals who are 65 years old or older. Additionally, young people with qualifying disabilities and individuals with end-stage renal disease may qualify for Medicare coverage.
What Is Medicare Billing Fraud?
Medicare fraud occurs when a healthcare provider gives false information to Medicare. As a result, the provider receives additional compensation beyond what is appropriate. In some cases, this may be as obvious as billing for a service never received. In other cases, such as unbundling a service in order to bill at a higher rate, the Medicare fraud is inconspicuous.
If you are the employee of a healthcare facility who receives Medicare compensation, it is important to always keep an eye out for any behavior that qualifies as Medicare fraud. If you are a recipient of services paid for by Medicare insurance, you can also play a role in reporting fraud. The False Claims Act indicates fraudulent activity can come in many forms, but with enough knowledge you can quickly spot a healthcare scam and become a whistleblower.
Examples of Medicare Billing Fraud
Medicare billing fraud can take on many different forms. In each circumstance, fraud always has one thing in common—medical information is being misrepresented and government funds are being misused as a result. Here are a few examples that qualify as Medicare billing fraud:
- A physician bills for a service, but the patient never received that service.
- A medical supply distributor submits for reimbursement for supplies never received by the person covered under Medicare.
- A false diagnosis is documented, allowing the healthcare provider to receive compensation for more expensive services or supplies.
- A group of services that are normally billed as one, such as a complete blood count, is unbundled into individual services, resulting in higher compensation.
- A medication is prescribed after the physician receives kickbacks from the company producing the medication.
- A test or procedure is upcoded, or billed as a more expensive service.
The Cost of Medicare Billing Fraud
When Medicare billing fraud occurs, government funds set aside for providing healthcare services for individuals over 65, young people with certain disabilities, or end-of-life conditions are improperly used. Loss of government funds is not the only consequence created by fraudulent behavior; it causes healthcare costs to rise for everyone in the United States.
If you suspect a healthcare provider of Medicare billing fraud, you can become a whistleblower. Your cooperation will not only play a role of reducing the occurrences of fraud within the healthcare system, you may also be rewarded. Under the False Claims Act, whistleblowers may receive as much as 25 percent of the recovered government funds resulting from the lawsuit. Without an attorney, you do not qualify for the rewards outlined by the False Claims Act and you cannot be protected from retaliation.
To learn more about becoming a Medicare fraud whistleblower, call 770.643.1606 to speak an experienced attorney at Bothwell Law Group.