Things You Should Know About Medicare Fraud | New Health and ...

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Social insurance programs like Medicare is important because it guarantees healthcare services for Americans ages sixty-five years old and older, and even to younger people who are unable to earn a living due to disabilities. Aside from paying for some of the costs incurred from hospital stays, and clinic visits, Medicare also gives its beneficiaries access to medicines that are sold at subsidized prices.

The sad thing is that the Medicare program is not immune to fraudulent activities. Fraud is prevalent in the Medicare program because its billing process is based on an honor system. At the same time, the Medicare system puts more emphasis on paying claims smoothly and quickly, and not so much on verifying if the claims are fraudulent. Medicare fraud can take the form of phantom billing where the healthcare provider or supplier bills for services or supplies that were never rendered or delivered.

It can also involve unbundling which is billing for multiple tests or services that are usually much cheaper when done together. Upcoding is also another tactic used by fraudulent providers and this involves submitting a bill for a higher CPT procedure codes than were actually performed, resulting in a higher payment by Medicare. Aside from medical professionals and suppliers, some patients can also defraud the Medicare program, like by giving their Medicare number in exchange for kickbacks.

Although majority of health care providers are honest and well-intentioned, the small number of providers who are intent on abusing the social program costs taxpayers an estimated thirty billion dollars a year. Also, the sad thing is that recent cases show that fraudulent medical professionals are often willing to risk harming the patient just to carry out their schemes. Ultimately, Medicare fraud affects all of us since it drives up healthcare spending.

As a taxpaying citizen or a beneficiary of this social program, you need to report Medicare fraud. However, before you make a complaint for billing errors, call your doctor or supplier first to have these rectified. In most instances, these errors are unintended and can be easily corrected. However, if they do not return your calls or do not cooperate, then call 1-800-MEDICARE or write the Medicare Company that paid the claim. You may also report Medicare fraud to the OIG.

Medicare fraud costs taxpayers money, and erodes resources otherwise spent for beneficiaries. Recent cases also show that fraudulent providers are willing to risk harming the patient just to carry out their schemes. Follow this link to learn where to report medicare fraud.

Source: http://newhealthandfitness.org/2012/02/23/things-you-should-know-about-medicare-fraud/

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