Medicare fraud can take many different forms. Whistleblowers need to know what to watch out for and what steps they can take when they see it happening.
At its heart, most Medicare fraud is financial in nature. The goal is simply for the provider or another entity to defraud the Medicare program. Here are some ways that it happens.
1. Authorizing unnecessary tests or treatments
For one thing, a provider may authorize certain procedures that are not even necessary. Maybe they know that a person does not need an MRI, but they order it anyway so that they can then bill Medicare for the services. The patient does not even know that the test is unnecessary or that fraud is being committed.
2. Billing Medicare for services that never happened
Another issue is simply when Medicare gets a bill for a service that was never provided to the patient in the first place. For instance, maybe the patient did receive a certain type of treatment and medication, but the bill lists three different treatments. Two of them never occurred, but have been lumped into the total.
3. Overbilling for services that were rendered
Finally, even in cases when services are provided, overbilling may occur. Perhaps the costs are inflated or low-cost treatments are provided while high-cost treatments are noted in the bill. It is just a way of manipulating the financial details.
Whistleblowers who believe they have seen evidence of Medicare fraud must know what legal options they have and what steps to take at this time. It may help to work with an experienced law firm.