What is Medicare Fraud? E-mail

A report entitled “What is Medicare Fraud?” recently issued jointly by the U.S. Department of Justice (DOJ) and the U.S. Department of Health and Human Services (DHHS) painted a convincing picture of the problem and its effect on all citizens. The report pointed out that the vast majority of doctors, suppliers, private companies and health care providers do a wonderful job and are completely honest in their dealings with Medicare.
However, it pointed out, the few who are not cost the Medicare Program and citizens millions of dollars per year.

In fact, one law which uncovers much of this fraud is the False Claims Act. Since 1987, prosecutions of fraud under this law have recovered over $22 billions, much but not all of it, from Medicare fraud.

The report showed how Medicare fraud ends up costing consumers more because it raises health care costs.

It listed some of the more common fraudulent activities perpetrated against Medicare, the government, and ultimately, all citizens.

The list included billing Medicare for services not rendered or rendered by an unqualified person; billing Medicare for equipment never furnished; billing Medicare for home medical equipment that’s already been returned; a company offering a Medicare drug plan yet to be approved by Medicare and a company using untrue information to cajole and mislead you into joining their Medicare plan.

Some common types of Medicare fraud that is reported to us include:

  • Hospice care centers overbilling for patients stays and care.
  • Rehabilitation centers systematically inflating rehab bills.
  • Durable medical equipment fraud: kickbacks schemes in medical sales of items such as bedding and wheelchairs.
  • Nursing home overbilling of staff time and patient care.
  • Assisted living center fraud.
  • Medical coding: alteration of medical codes for different procedures and diagnosis.
  • Ambulance service fraud: billing for rides not authorized by Medicare.

The report said that the U.S. Department of Health and Human Services (HHS) and U.S. Department of Justice (DOJ) work closely together to eliminate fraud. They, often working in concert with the FBI, investigate Medicare and Medicaid operators who are cheating the system.

Attorney General Eric Holder and HHS Secretary Kathleen Sebelius are taking the fight against Medicare and Medicaid fraud to a new level. The two organizations work together under the recently formed Health Care Fraud Prevention and Enforcement Action Team (HEAT).

Another great aid in the fight is the whistleblower provision in the False Claims Act. This provision allows citizens to file suit on behalf of the government whenever a citizen, often a contractor employee, detects fraud being committed against the Medicare program.

Individuals that report Medicare fraud are typically employed as healthcare industry professionals.

Report Medicare fraud here.

Are you a healthcare professional that wishes to report Medicare fraud? Help put an end to Medicare fraud, and get rewarded for your efforts. Our attorneys have significant experience representing Medicare fraud whisteblowers. Report Medicare fraud by Completing the form on this page or by calling 1-800-581-1790 for a free no obligation consultation with a lawyer.


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