Medicare fraud is a problem of high importance when it comes to healthcare and as the years go by, it is seeming to become more and more rampant. I chose this topic because my parents own a home health care business in Houston and they mentioned Medicare fraud as one of the main things they look out for and try to prevent. Generally, Medicare fraud is a person or company that aims to collect healthcare reimbursement illegally. The most common form of Medicare fraud is billing a patient for services he or she never received. Even though the majority of healthcare providers out there are trust worthy and have good intentions, the few that deliberately choose to abuse the system are putting their patient’s healthcare and welfare at tremendous risk. In return, Medicare is losing a lot of money because of all the fraudulent activities happening in healthcare. It is our duty to learn ways to protect ourselves from Medicare fraud by knowing what Medicare fraud is and knowing the types of Medicare fraud. It also important to know how to prevent ourselves from being victims of Medicare fraud by knowing all the things we should and shouldn’t do when it comes to our healthcare which shall be addressed in this paper.
Before discussing the types of Medicare fraud and how to prevent them, it is important to explain why Medicare fraud is such an important issue and how much damage it is doing. Medicare fraud cost the government a lot of money. Tracking it is difficult because not all cases are reported and not all suspicious cases turn out to be fraud. The total spent on Medicare alone in the US is an estimated $528 billion. Out of that, Medicare lost an average of $60 billion due to fraud in 2012 alone. That is a lot of money to be losing to fraud and that’s why the abuse of Medicare is one of the things the government is looking out for. All this money makes healthcare costs for everyone else increase. It also increases the cost of services for those who actually need the healthcare. Eliminating fraud will decrease the cost for many families and businesses.
There are many different types of Medicare fraud to be discussed but I will be addressing the main ones. The first and most common type is called Phantom Billing which occurs in various ways. Phantom Billing occurs when medical providers bills Medicare for unnecessary procedures or procedures that their patient never even received. This involves billing patients for unnecessary tests or tests that were never performed. Another type of Phantom Billing is charging the patient for supplies that were used or never ordered. Another form is billing the patient for expensive and new equipment when the equipment was actually cheap and used.
Another common type of Medicare fraud is patient billing. This is the opposite of phantom billing because in patient billing because the patient is in on the scam. A patient who is on the scam will routinely offer to give his or her Medicare number in exchange for kickbacks....