Common Types of Medicare/Medicaid Fraud
Medicare fraud is a general term that refers to any individual or company seeking to collect Medicare reimbursement payments under false pretenses. This can be accomplished in a number of different ways:
Fraudulent Billing: an individual or practice bills Medicare for procedures, tests or medical equipment that were either never given or medically unnecessary. Other examples include billing for brand-name drugs when generics are given, charging for "phantom" employees' hours on the job and charging a doctor's rate for work that a nurse or assistant performed. Given how expensive they are, HIV/AIDS infusions and high-power wheel chairs are two of the most common items criminals now use to bill Medicare.
Patient kickbacks: many medical centers will reach out to homeless or drug-addicted individuals and offer them in cash or drug kickbacks in exchange for going along with the fraudulent scheme. This includes participating in mock procedures, offering their Medicare information or signing their name on fake bills.
Upcoding: billing for a more costly service than the one actually performed.
Upbundling: billing for every stage of a procedure as if each stage was its own, separate procedure.
Identity Theft: medical professions stealing patient information and using it to over-bill Medicare.