A year ago, four Florida residents were convicted of billing the government for $70 million worth of mental health care that either wasn’t administered or wasn’t medically necessary.
This March, the owners and several employees of a Houston medical facility were convicted in a $97 million fraud scheme where the government was billed for treatment “when the beneficiaries were actually watching movies, coloring and playing games.”
These are just two recent cases of Medicare fraud — a pickle that continues to bleed billions of dollars out of the Treasury each year.
According to the U.S. Department of Health and Human Services, the Medicare Fraud Strike Force has charged almost 1,900 defendants in fraud schemes that total almost $6 billion since 2007.
And that’s just the fraudsters who have been caught.
Still, despite the scope of the problem, many Americans aren’t familiar with how Medicare fraud works and how it affects them.
Here are some common examples of Medicare fraud — and how they can be prevented to save taxpayer dollars and ensure a high quality of care for American seniors who rely on Medicare treatment to stay healthy.
Medicare Fraud Case #1: Fake Charges
One of the more common ways Medicare fraud is committed involves the government getting a bill for treatment that was never administered.
For instance, in February, a Seattle doctor pleaded guilty to billing Medicare for nursing home visits for patients who were dead.
This is an extreme case. More commonly, unscrupulous doctors will simply add an extra test or procedure to your bill or charge you twice for services that were received.
How to prevent it:
If you ever find additional or duplicate charges on your Medicare statement, contact your provider immediately or call 1-800-MEDICARE. You may be eligible for a $1,000 reward if your tip helps the police uncover a fraud scheme that is sizable and affecting other patients.
Medicare Fraud Case #2: Unnecessary Treatment
Just because a patient actually receives treatment from a real doctor, that doesn’t always mean the charges are legitimate.
Physicians are frequently targeted by unscrupulous Medicare providers, and promised bribes or kickbacks for sending patients along for treatment — whether they need it or not.
It’s deceptively simple: Doctor A tells all his patients to go to Doctor B for mental health treatment. Doctor B bills Medicare a fortune for all those services, and passes a cut of the money back to Doctor A for sending him plenty of “customers.”
This kind of Medicare fraud can happen on a massive scale, as illustrated by the recent allegations from two North Carolina ER doctors who claimed the company running their hospital tried to bribe them into admitting more patients and administering unneeded tests just to juice corporate profits.
How to prevent it:
Without medical training, it’s very difficult to know what treatment is legitimate and what is not needed. However, there are some warning signs to look out for.