Medicare fraud is an expensive problem in the United States. Fraudulent charges to the system cost taxpayers billions of dollars every year.
The problem is growing, and it affects everyone.
If you work in a hospital or clinic, you may see instances of Medicare abuse. Here are a few methods used to commit Medicare fraud:
As the name suggests, phantom billing involves billing Medicare for non-existent services. Hospitals might charge for optional procedures or unnecessary tests.
Scheduling unnecessary scans or ordering optional blood tests qualifies as well.
Doctors can also increase the cost of procedures when submitting bills to Medicare. Raising the price of an X-ray scan or the rate of consultations are easy ways to charge more.
These small increases may not seem important, but they add up to billions of dollars.
Charging for free supplies
Certain companies offer free trials of prescriptions or equipment. It’s perfectly legal to give small prescription samples to patients that need them.
Fraud occurs when a hospital or physician bills Medicare for supplies they got for free.
Hospitals in some areas face stiff competition for patients and employers. When this is the case, organizations feel pressure to offer incentives to hire the best staff or attract more patients.
Doctors should recommend facilities best suited for their patients. Unfortunately, incentives can play a role in where a patient goes for treatment.
Sometimes hospitals send patients to more expensive facilities because of incentives. Specialists may be suggested based on rewards instead of need.
The extra charges for these expensive facilities or extra specialists are billed to Medicare.
Investments in healthcare businesses
Occasionally, physicians or hospital staff will invest in businesses in the healthcare field. This is not an issue until doctors or hospitals begin to refer patients to a business because of their financial interest in the company.
Referring patients to businesses because of personal interest can be dangerous to the patients and costly for the government.
These are just a few ways Medicare fraud happens. Unfortunately, this is an ongoing problem that costs taxpayers every year.
If you recognize signs of Medicare fraud, an attorney knowledgeable about whistleblowing laws can help you bring the abuse to light.