Medicare Fraud
tachosomoza
Regular
3 Types of Medicare Fraud
1.) Phantom Billing: The medical provider bills Medicare for unnecessary procedures, or procedures that are never performed; for unnecessary medical tests or tests never performed; for unnecessary equipment; or equipment that is billed as new but is, in fact, used. In which case, every form of billing, phantom or patient, can be prevented through carefully checking.
2.Patient Billing: A patient who is in on the scam provides his or her Medicare number in exchange for kickbacks. The provider bills Medicare for any reason and the patient is told to admit that he or she indeed received the medical treatment.
3. Upcoding scheme and unbundling: Inflating bills by using a billing code that indicates the patient needs expensive procedures.
Durable Medical Equipment (DME) is a particularly susceptible to Medicare fraud. DME is used to describe any medical equipment used in the home to aid in a better quality of living. Examples include wheelchairs or oxygen tents. In a DME fraud, scammers will charge Medicare for the same wheelchair many times over, never once actually delivering the chair to an actual person.
Recent Medicare fraud, however, focuses on HIV/AIDS infusion injections. These injections are very expensive and can sometimes cost hundreds or thousands of dollars per injection. Patients are recruited to receive these injections but are actually injected with saline solution or some other common liquid. Medicare is billed as if the expensive injection was actually given.
Even in other countries, particularly in South-East Asia, there are doctors who over-charge American patients, through Medicare (or Tricare), charging them US rates, much higher than actual medical cost in their respective countries. This is a type of insurance fraud, which, unfortunately, Medicare continually overlook and fail to take into account.
CBS did a special on this on 60 Minutes back in '09, calling it the $60 billion crime. Immense profit, if one isn't a complete idiot and knows the ins and outs of dummy companies, money laundering, and the like.
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