Definition of Medicare & Medicaid Fraud

Types

Medicare and Medicaid fraud can be committed by health care providers and by recipients of these benefits.

Identification

Medical Providers--health care providers offering rewards for referral of patients, services not delivered to a valid patient, billing separately for services normally performed together, submitting claims for services not needed medically, fraudulent statements concerning terms of a contract to get a claim paid or to obtain additional business, research grant fraud, having an improper financial interest in services provided to their patients, and hospitals inflating or falsifying costs on reports to acquire maximized reimbursements.

Recipients--by using more than one benefit card, selling supplies given by Medicare, getting duplicate services or supplies, and making false claims to receive or continue receiving benefits.

Effects

Fraud steals money from those who need it the most, it's a waste of taxpayer money, increases costs for indigents in valid need of health care and increases general health care costs for everyone.

Warning

Penalties for committing Medicare and Medicare fraud are Civil Monetary Penalties and Criminal and Civil Enforcement. For more information, visit the U.S. Office of Inspection General at http://www.oig.hhs.gov/fraud/enforcementactions.asp.

Prevention/Solutions

Several online whistleblowing resources have been created to prevent or solve fraud. For information, see http://www.quitamonline.com/library.html. Medicare and Medicaid fraud is committed on a daily basis, harming the indigent, government and taxpayer.