Sadly we live in a day when some of those that are supposed to be keeping us in health instead take risks with our health for their own personal gain. While most physicians and clinics are free from Medicaid and Medicare fraud, there are many that use patients in order to gain access to these funds, and in doing so risk the health and safety not only of their own patients but also of others who depend on these funds for actual health issues. There are many ways in which Medicare and Medicaid fraud can occur, and knowing how to spot these crimes will help you from falling victim to them.
- Billing fraud. Billing fraud is one of the most common abuses of the Medicare/Medicaid system. There are many different scams that are perpetrated. One is billing for services that were never rendered, either by using genuine patient information, identity theft, padding real claims with false information or simply by fabricating entire claims altogether. Billing fraud is rarely committed by one person. All those who knowingly participate in billing fraud can be held liable. Reporting this type of fraud will prevent you from being found financially responsible for the theft.
- Falsification of patient diagnosis. Another type of Medicare/Medicaid fraud is the falsification of patient records, including tests and exams, in order to justify surgeries, treatments, procedures or drug regiments. As a patient, nurse or loved one, it is important to carefully check the information you are given to ensure that a proper diagnosis has been given. Falsification of patient records that leads to unnecessary procedures can cause serious damage and even death to these victims. Convincing patients that they have a life threatening condition that must be treated by some medical procedure is both unethical and unlawful and these physicians need to be reported for health care fraud.
- Unbundling of procedures. Medical procedures often require multiple steps. Typically, these steps are bundled into one cost instead of being billed separately. Unscrupulous physicians will sometimes have their accountants bill each step separately instead of in a bundle as it is supposed to be. Unbundling means that the doctor or clinic will receive much more money for the service than is deserved, and fewer funds are left over for other work.
- Kickback fraud. We have all heard of kickback fraud, but do you know how pervasive it actually is? Pharmaceutical companies wine and dine doctors and clinics, offering substantial kickbacks to those who push their prescription drugs. When these drugs are actually necessary for a real medical condition and result in a bettering of a condition for the patient, then no harm is done. However, all too often physicians write prescriptions for drugs which have absolutely nothing to do with the patients condition simply to take advantage of kickbacks. As well, if patients must return to the doctor month after month for a prescription refill, they profit off the charge of each office visit. Kickback fraud can be dangerous because often the drugs prescribed cause harmful side effects in patients, some even leading to death.