Medical fraud happens when your doctor or health care provider cheats you to receive higher reimbursements or unnecessary payments. Any activity in which doctors, insurers, or others attempt to claim money from the Medicare program improperly is considered Medicare fraud.
Some examples of medical fraud include:
– Charging for non-existent services.
– Charging for medical equipment that was not received or was returned.
– Double billing for medical services.
– Billing Medicare for missed patient appointments.
– Overcharging the insurance company.
– Prescribing unnecessary medications to receive a profit from the sale.
– Not administering the medication to the patient and keeping the drugs for personal profit.
– Offering or accepting kickbacks for patient referrals or services.
– Ordering inappropriate or excessive tests, therapies, or treatments.
– Falsifying prescription drugs that are stolen or altered.
– Billing for a service that was provided at a higher cost.
– Use of your Medicare number or card by another person.
– Billing each stage of service as if it were a separate procedure.
– A company was offering you drugs that Medicare did not allow.
– Falsifying a patient’s diagnosis to perform unnecessary medical procedures.
Because of these frauds, individuals may be subjected to risky and unregulated procedures. These illegal activities raise Medicare costs and put patients in potential danger. Also, these fraudulent charges cost U.S. taxpayers millions of dollars a year. This money goes into the pockets of dishonest and unethical medical providers.
Medicare fraud is a federal crime with severe consequences. It is legally sanctioned, and penalties for committing medical fraud may include the following:
– Monetary penalties up to $250,000.
– Civil prosecution
– Imprisonment for up to life
– Loss of medical license.
– Exclusion from public health programs.
– Criminal conviction and fines.
What can you do to avoid becoming a victim of fraud?
– Protect your Medicare number and card. Give your card only to your doctor and Medicare employees who work on your behalf.
– Regularly check your bills for charges you do not recognize. Call your healthcare provider’s office immediately if you think there is a mistake on your invoice.
– Never share your Medicare information by phone or email.
– Only Medicare doctors and providers can review your medical records and recommend medical services. Never let someone else review your medical information.
– Refuse to accept offers or gifts of free health care.
– Decline to sign up for Medicare health or drug plans by phone unless you have called the Medicare phone number.
– Understand how Medicare will use your data. You will be informed about the use of your information when you sign up for a Medicare health or drug plan.
– Never feel obligated to join a specific Medicare plan. Ensure you understand what the program provides and how it may affect your benefits. Request further information about the plan’s advantages in writing.
Remember, Medicare does not make phone calls or home visits to offer you medical services. Only in these two situations will Medicare ask for your personal information:
1.- The staff who helped you join Medicare may call you if you are already a plan member.
2.- If you called the 1-800-medicare customer service number and your call was not answered, a medicare representative may contact you if you request a callback.
What to do in case of fraud?
If you believe you were a victim of fraud, contact your service provider to clarify your concerns. They will be able to explain the charges and help you determine if a billing error occurred. Please have the following information available to ease the process:
– Your Medicare name and number.
– The name of the provider you are claiming against and any information you have from the provider.
– The service you are disputing and the date of the charge.
– The monetary amount Medicare approved and paid.
– The breakdown of your medical or drug plan benefits.
How do I report a suspected Medicare fraud?
There are several ways to report Medicare fraud, which can be done anonymously. You can receive monetary rewards for reporting fraud.
– Contact 1-800-medicare if you have experienced Medicare fraud or provider abuse. Includes claims for services not provided or fraud in a Medicare Advantage plan or Medicare drug plan.
– You can report fraud directly to the Office of the Inspector General (OIG) by calling 1-800-HHS-TIPS. Also, you can contact the OIG online (Forms.oig.hhs.gov/hotlineoperations/index.asp). Your inquiry or call will be confidential, and you may be eligible to earn a reward of up to $1,000.
The OIG conducts audits, investigations, assessments, and other related duties around the country. Individuals and businesses participating in fraud or abuse can not participate in Federal healthcare programs.
How to report Medicare fraud anonymously?
If you wish to report fraud and abuse anonymously to the OIG Hotline, the OIG record systems will not collect information that might be used to track the complaint back to you. But, a lack of contact information may prohibit the OIG from conducting a thorough assessment of the complaint. Thus the OIG encourages you to provide contact information for future follow-up.
Where Can I Get Help?
– Professional Organizations. Your medical society can be a good resource for physician-related concerns. These societies have a list of health lawyers in your area, which you can consult to seek legal advice.
– Centers for Medicare & Medicaid Services (CMS). Contact your Medical Administrative Contractors (MAC) for more information about appropriate billing practices and coverage policies.
– OIG. Read the OIG Compliance Program Guidance and visit the Compliance Education Material for more information about fraud and abuse risk areas.
– Consult a healthcare fraud attorney
Experienced healthcare attorneys may examine your issues and provide a legal study and risk analysis of the planned enterprise, partnership, or arrangement.
At khourilaw.com, our healthcare attorneys have extensive experience in medical fraud. We understand that deciding to report Medicare fraud is not easy, and we will guide you through every part of the process. Our attorneys will work with you to protect your interests, prevent retaliation, and collect your reward. Please contact us if you suspect Medicare fraud, and we will evaluate your case.