Medicare fraud is one of the worst plagues upon the nation. This is because the crime is carried out by the very people who are tasked with ensuring that the general public is healthy. These are people who are in need and who are helpless. But fear not — while these scams may be elaborate, a little bit of vigilance and knowledge will not only save you a lot of money, it’ll give you the ability to help others avoid these scams as well.
Now, as managers of the household, it’s our responsibility as moms to ensure that we aren’t wasting money, and that each penny spent is a penny well spent. Medical health is an integral part of our security as it helps us avoid hefty bills when money is direly needed, and instead allows us to make regular and sustainable payments. So, how do you detect healthcare fraud? Read on.
1. Medicare Billing
Scammers will often bill you for medical services that you never received. Other times, they’ll bill you for services that weren’t necessary to begin with. These services may be something as small as tests and minor treatments, which are easily concealed. However, there are times that billing errors are made. Either way, these will cost you money. Avoid this situation by taking the time to take note of the treatments and tests you do take and by going through your bill’s breakdown.
Sometimes, you’re billed for products and services that you didn’t receive, other times, you’re billed for the right products and services, but you’re billed for the more expensive variants versus the stuff that you actually got. Like Medicare billing fraud, you can avoid “upcoding” by knowing exactly what type of services and products you actually got and by checking the breakdown of your bill.
3. Service Unbundling
There are Medicare regulations that strictly suggest that certain services be offered at lower “bundled” rates. As you may have guessed, scammers unbundle these services in order to charge full rates for them. This article illustrates the different payment bundles and the services encompassed by each payment model. Memorizing these payment models is a Herculean task. So, what you can do is to get once again a breakdown of what services are included in your payment bundle and by counterchecking that list with the bundles in the article. Check for any missing services and see if the hospital is charging for these services separately.
4. Patient Record Falsification
Like the previous three scams, this fourth one is easily detected with a bit of vigilance. The reason why scammers falsify patient records is so they are able to file reimbursement claims. Scammers use this method in order to defraud the government. Simply double-check your patient records to ensure that each detail stated is accurate and truthful.
Now, these are but a few of the most common Medicare scams. There are many more elaborate schemes, but knowing how to recognize medicare fraud will also allow you to file a qui tam lawsuit against the scammers. A qui tam lawsuit will not only reward you financially for exposing a scam that defrauds the government, but you are also doing your part in cleaning up Medicare.