Here are three of the most common cases.
Phantom Billing: In this instance, medical providers bill Medicare for procedures and unnecessary services that were never performed, or for equipment and supplies that have already been used. Such cases are often discovered by the government upon review of the paper work and medical records.
Patient Billing: When a patient collaborates with a doctor, he/she provides the insurance information to the health care provider which they use to bill Medicare as a scam. The patient is often paid a part of the proceeds and is legally at risk for this activity.
Up coding and Un Bundling: Up coding and Un Bundling is the most common type of Medicare Fraud where provider offices might not be aware of having broken the law. In this scenario, services codes are up-coded to show and get reimbursed for higher collected amounts. It also involves claim of services that are bundled with the primary procedure with an inappropriate or erroneous use of a modifier.
The penalties for Medicare fraud are outlined in the 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 possible deportation 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