Medicare Fraud -- An Overview
Medicare is a specific type of health insurance that is provided by the
federal government to certain groups of people, including those over
age 65. Medicare fraud has been an increasing problem in the United
States government and there are serious repercussions for those that
engage in it. It can be committed by a wide variety of personnel, from
health insurance billers to even doctors.
What is Medicare Fraud?
First of all, what is fraud? Fraud, by definition, is being
intentionally deceptive to acquire something of value, usually money.
Medicare fraud is essentially "tricking" the government into paying for
health care services that there is no entitlement to. This type of
fraud can take place in many health care settings: hospitals, doctor's
offices, nursing homes, among others.
How Does Medicare Fraud Work?
There are many ways that people can engage in Medicare fraud. The
government does take into consideration, however, that sometimes
genuine mistakes are made and the intention was not to be deceiving.
Too often, though, Medicare fraud is the intent. One of the most common
ways to commit this type of fraud is for a provider to submit a bill
for services done in a health care facility that were never actually
Also, whenever a patient goes to the hospital or even for a simple
doctor's visit, there is a "code" assigned by a medical biller or coder
for each treatment and service provided. If one of these codes is
deliberately "upgraded," this would be a form of Medicare fraud. For
example, submitting a bill for stitches performed on a patient with a
cut, when in actuality, they just had a bandage put on it.
Some other types of common forms of Medicare fraud include billing for
medical equipment that was never ordered, charging twice for the same
service, and someone using another person's Medicare card to get
services or treatment for themselves.
Consequences of Medicare Fraud
There are serious punishments for people that are convicted of Medicare
fraud, and there are laws currently in motion that would make current
consequences much more severe. Committing Medicare fraud can be
prosecuted as either a state or federal crime, depending on the
A large number are prosecuted as a federal crime with harsh outcomes.
For example, defrauding the government can result in being charged with
violating the "False Claims Act," and being liable for three times the
dollar amount that was deceptively taken. It can also include fines of
$5,000 to $10,000 for each false claim.
In some cases, it can even result in jail time of up to five years for
each offense. Some other penalties for committing Medicare fraud
include probation and being banned from participating in any federal
health care program for a certain amount of time.
Medicare Fraud -- Conclusion
For people working in a health care setting, it is best to be 100%
honest at all times. Even if bribery is involved and there is
temptation, being truthful can save someone from being convicted of a
serious offense resulting in huge fines and even jail time. As the old
saying goes, "honesty is the best policy."