As eminent from the name Medicare Fraud is basically being guilty with Medicare or being involved in abusive Medicare payments. It’s difficult to say how much money is lost every year under the Medicare fraud but do you actually know how many different types of Medicare frauds there are?
Medicare fraud is typically of three types each one of them is given below;
Phantom Billing: In this type of Medicare Fraud, medical providers bill Medicare for procedures and unnecessary services that were never performed equipments and supplies that have already been used. Such frauds can be caught up by the Govt. upon review the paper work and medical records.
Patient Billing: Under such fraud patient is involved with the doctor, he/she provides the insurance information to the health care provider which they use to bill Medicare as a scam. Patient is paid on part of scam money and admits to any service upon any follow up or investigation until proven.
Up coding and Un Bundling: Up coding and Un Bundling is the most common type of Medicare Fraud which provider offices might not be aware of that they are involved in. Under this abuse services codes are up-coded to show and get reimbursed for higher money and reimbursements. It also involves claim of services that are bundled with the primary procedure with an un-appropriate or erroneous use of modifier
If found guilty? Fraudulent party would have to face strong penalties according to Federal Sentencing Guidelines and HHS program. The Inspector General for the U.S. Department of Health and Human Services under Public Law mandate 95-452 protects Medicare and Medicaid fraud. HHS department works in close collaboration with Federal Bureau of investigation to prevent Medicare Fraud.
Defendants can expect to have jail for a substantial amount of time, compensations, fines and deportation from country if not a US citizen.
At Medcare MSO we make sure that our client’s bills are legitimate and they are following the right steps to meet all of the standards and regulations. To find out more about Medicare fraud and abuse please call us today at 800-640-6409.