The Medicare program is a federally-funded medical plan for Americans age 65 and above that covers medical expenses such as clinic visits, hospital admissions, medications and other treatments. However, this program has been a target for fraud probably because it has few safeguards to weed out false claims.
There are various tactics employed to carry out Medicare fraud, and phantom billing is an example. In this tactic, the physician submits a claim to Medicare for treatments, services, and diagnostics which were never rendered. This can also involve durable medical equipment companies and drug dispensaries making claims for supplies or goods that were never given to patients. Tactics like upcoding and unbundling are also quite prevalent. Upcoding is the practice wherein the insurer, in this case Medicare, is billed for a service with a higher CPT code than what was actually performed, resulting in higher reimbursement.
Unbundling is the practice of breaking down services like blood and chemistry panels into individual components, resulting in a higher payment by Medicare. Identity theft is also a common Medicare fraud scheme and this involves using another person’s Medicare information to get medical care, supplies, or equipment.
Fraud costs the Medicare program millions of dollars annually, and you end up paying for this with higher health care costs. This underlines our responsibility to report Medicare fraud. To spot Medicare fraud, you have to make it a habit to record the dates and save receipts and statements you get from providers every time you get healthcare services. Compare these against your Medicare summary notice and check for entries that are erroneous. If you find any billing errors, call the provider or supplier first, so they will be notified about it and make necessary corrections. However, if they do not return your calls, or refuses to help you correct those errors; don’t hesitate to contact the Medicare hotline at 1-800-MEDICARE. The earlier you notify Medicare of the problem, the sooner they can address it as well.
Also, protect your Medicare number. Be suspicious of individuals who says they will give you free medical equipment or services and asks to look at your Medicare ID. Remember, if it’s free, why do they need your number? Lastly, do not lend your Medicare ID to anyone or offer it for rent.