Medicare fraud is a serious issue that affects millions of people in the United States. It is estimated that Medicare fraud costs taxpayers billions of dollars each year. As a result, it is important to be aware of the signs of potential Medicare fraud schemes. A Medicare fraud whistleblower is someone who reports suspected fraud or abuse of the Medicare system.
Whistleblowers can be employees, patients, or anyone else who has knowledge of potential fraud. One of the most common signs of potential Medicare fraud schemes is billing for services that were not provided. This could include billing for services that were not medically necessary or billing for services that were never performed. It could also include billing for services that were provided by an unlicensed provider or billing for services that were provided to an ineligible patient.
Another common sign of potential Medicare fraud schemes is upcoding. This is when a provider bills for a more expensive service than was actually provided. For example, a provider may bill for a more expensive procedure than was actually performed or bill for a more expensive medication than was actually prescribed. Another sign of potential Medicare fraud schemes is unbundling.
This is when a provider bills for multiple services as separate procedures when they should be billed as one procedure. For example, a provider may bill for each step of a procedure as separate procedures instead of billing for the entire procedure as one procedure. Finally, another sign of potential Medicare fraud schemes is kickbacks. This is when a provider pays or receives money in exchange for referring patients to another provider or service.
Kickbacks are illegal and can lead to serious penalties if discovered. It is important to be aware of the signs of potential Medicare fraud schemes in order to protect yourself and your loved ones from becoming victims of fraud. If you suspect that someone is engaging in Medicare fraud, you should contact your local law enforcement agency or the Office of Inspector General at the Department of Health and Human Services.