Medicare Fraud and Medicaid Fraud
The largest area of fraud today is against Medicare and Medicaid. Some estimate that as much as 10% of all bills are inflated or improper. That helps explain why the Department of Justice pays such large rewards. It needs your help in uncovering fraud. Below are just a sampling of the ways hospitals and others health care providers cheat:
- charging for tests, services or supplies not actually provided
- falsely stating how many hours were spent (i.e. routinely adding 30 minutes)
- charging for tests or services not really needed (i.e. routine ordering of blood work, frequently requesting a full panel of tests where only one or two are needed, or providing psychotherapy to people with Alzheimer disease)
- lying about any work or service performed
- upcoding (i.e. patient really has "bronchitis", but Medicare is knowingly billed for treating "pneumonia")
- billing for unallowable or unreasonable costs of goods or services
- billing for routine supplies (i.e. band aids, lubricants, irrigation solutions, gloves, slippers, prep kits, towels, monitors, humidifiers, oxygen [by the hour], anesthesia circuits, elbow or heel pads, mask, electrodes for ECG, and foam head rests)
- charging incremental nursing services (i.e. IV starts, and stat or monitor charges)
- unbundling services billed to Medicare (i.e. billing for individual tasks that really consist of one larger procedure)
- receiving or paying kickbacks for client referrals or to use particular products
- cost report fraud (i.e. including unallowable or unreasonable costs in hospital cost reports)
- billing for samples of drugs the hospital or doctor received for free
- claiming ambulance costs for routine or non emergency travel
- using unskilled or unlicensed workers
- charging for investigational tests
- disguising advertising or marketing costs as other costs
- billing ambulance services for non-emergency transportation