Medicare fraud occurs when someone intentionally bills Medicare for services or items that were never provided. This can take many forms, including using someone else’s Medicare card or billing for a different service or item. Recipients should be aware of signs of fraud, such as providers offering free services but still requiring Medicare card numbers.
Medicare fraud occurs when someone charges Medicare for services or items that were never performed or provided. However, not all payment error cases are considered fraud. Sometimes errors occur due to clerical errors or some other problems. Instead, this type of situation is only called Medicare fraud when the billing for the issue is done intentionally.
This type of fraud is not limited to just one type of deed; it can have many faces. For example, if a person bills or allows a provider to bill Medicare for services they never received, it is considered fraud. A person can also commit fraud if he receives a service or piece of equipment from one provider but charges Medicare for an entirely different service or item. Medicare fraud also occurs when a person receives medical equipment and returns it, but still bills Medicare for the equipment.
Sometimes a bill is entirely accurate, even when Medicare fraud has occurred. This happens when someone uses a Medicare recipient’s card to gain access to services and equipment that they aren’t entitled to. This can happen when a person obtains the card illegally, such as by stealing it or by finding a way to copy it. However, this situation is still considered Medicare fraud if the intended recipient voluntarily allows the other person to use the card.
There are a few tips that can lead a person to suspect that their health care provider may be committing social fraud. For example, if a provider tells a recipient that a certain test or procedure is free, but they still need Medicare card numbers for record keeping, this could be a sign of fraud. You may want to bill Medicare more than you are entitled to or for a completely different test or procedure. It is advisable to keep in mind, however, that some clinical laboratory tests are indeed free for recipients. For this reason, it helps to learn the ins and outs of Medicare coverage; this kind of knowledge can help identify fraud.
A recipient should also be on the lookout for clinics and/or doctors offering to waive payouts or offer gifts or incentives to join the office. If a provider says they know how to charge Medicare for certain services, this could be a sign of intent to commit Medicare fraud as well. Recipients should also be wary of and report providers who charge for clinical laboratory tests and covered preventative services.
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