{"id":5793,"date":"2019-09-12T08:00:39","date_gmt":"2019-09-12T12:00:39","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=5793"},"modified":"2024-10-02T11:08:30","modified_gmt":"2024-10-02T15:08:30","slug":"what-is-medicare-fraud","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/what-is-medicare-fraud\/","title":{"rendered":"Learn what Medicare fraud is\u2014and how you can watch out for it"},"content":{"rendered":"

What is Medicare fraud?<\/a> | Penalties<\/a> | Medicare fraud examples<\/a> | How to identify Medicare fraud<\/a> | How to report Medicare fraud<\/a> | What happens when you report Medicare fraud<\/a> | Healthcare fraud prevention<\/a><\/p>\n

In its simplest form, Medicare fraud is when someone obtains healthcare benefits from the program by lying or cheating. But it can also involve billing for services that were never provided or charging more than the allowable amount for a service. While scams involving Medicare fraud and abuse can take many different forms, all of them aim to take advantage of the system in some way and steal taxpayer money.<\/span><\/p>\n

\u201cMedicare fraud occurs across the board\u2014from doctors, hospitals, labs, to even beneficiaries who sell their numbers or give their cards to others,\u201d says Charles Clarkson of the <\/span>Senior Medicare Patrol of New Jersey<\/span><\/a>.<\/span><\/p>\n

What is Medicare fraud?<\/span><\/h2>\n

The Centers for Medicare & Medicaid Services (CMS) defines fraud as \u201cthe intentional deception or misrepresentation that the individual knows to be false or does not believe to be true\u201d and that is made \u201cknowing that the deception could result in some unauthorized benefit to himself or herself or some other person.\u201d<\/span><\/p>\n

Medicare fraud is a huge problem for the government, costing American taxpayers around <\/span>$60 billion<\/span><\/a> every year. Health Payer Intelligence stated The CMS paid more than $160 million to Medicare Advantage claims for medications that were already paid for by Original Medicare.\u00a0\u00a0<\/span><\/p>\n

Medicare is a great program with many resources, which sometimes causes criminals to take advantage of the system. There are two main ways that this happens: selling identification numbers and stealing identification numbers.<\/span><\/p>\n

A provider committing fraud could attempt to use a stolen Medicare number to order services or durable medical equipment\u2014like a knee brace\u2014without the beneficiaries’ knowledge. Or providers might intentionally bill for services or items not provided so that they may collect the funds.<\/span><\/p>\n

Penalties for Medicare fraud and abuse<\/span><\/h2>\n

Medicare fraud is illegal and considered a felony. Anyone who commits it could face criminal, civil, or administrative consequences including jail time, fines, or penalties\u2014like loss of medical licenses or exclusion from participating in any federal healthcare programs.<\/span><\/p>\n

Medicare fraud hurts everyone. \u201cMedicare fraud steals tax dollars that are coming out of every American\u2019s paychecks,\u201d said federal investigator Shimon Richmond in a video for <\/span>AARP<\/span><\/a>. \u201cIt steals from a program that is providing services that every American hopefully will be able to take advantage of or may need at some time.\u201d It\u2019s passed along to citizens in the form of higher taxes to cover the program and can result in decreased services for participants as plan administrators cut programs to cover rising costs.<\/span><\/p>\n

Medicare fraud examples: How to identify Medicare fraud<\/span><\/h2>\n

For providers, Medicare fraud examples could be:<\/span><\/p>\n