Senior Medicare Patrol

Medicare/Medicaid Fraud: Who Pays? You Pay!

When Medicare and Medicaid fraud is committed – Who pays? You Pay! We all Pay! Volunteers are being recruited through Area Agencies and Aging throughout Virginia. If you are interested in becoming a volunteer and would like assist with SMP outreach and training, or you have a question or concern about Medicare or Medicaid fraud, please call: 1-800 938-8885
In Richmond: 644-5628

How Much Money Is Lost In Health Care Fraud?

Experts report $56,000 are lost each minute. Recent studies have shown that health care fraud is bigger business than drug dealing.

Why should YOU care? Who Pays? You pay! Cheaters hurt the beneficiary because their actions cause your premiums to go up, and benefits to go down. In some cases, the services are of less quality.

Who might commit health care fraud? Where is health care fraud committed? We are talking about provider crimes in these areas:

Home Health Services
Durable Medical Equipment (DME) Suppliers
Pharmacies
Nursing Homes
Physician's Practice
Hospital
Laboratories
Hospice Services
Transportation Providers

FRAUD IS:

An intentional deceptions or misrepresentation which could result in unauthorized benefit.

It May Be Fraud If It Sounds Like:

Billing for services or supplies not provided.
Altering claims to obtain a higher payment.
Applying for duplicate payment.
Using another person's Medicare card.
Soliciting, offering, or receiving kickbacks, bribes, rebates, or other payment for patient referral.
Unnecessary lab services.
Billing for equipment not delivered.
Billing for non covered services as covered.
Unnecessary ambulance service.
Continuing to bill for items (DME) no longer used.
Billing for home health aides who do not show up for work.

ABUSE IS:

Incidents or practices inconsistent with sound medical or business practices.

It May Be Abuse If It Sounds Like:

Charging excessive amounts for services or supplies.
Claims for unnecessary services or supplies.
Breaching the assignment agreement.
Improper billing, i.e. billing at a higher rate than for non-Medicare patients.
Billing Medicare instead of primary insurers.
Issuing denial notices to beneficiaries regardless of services.
Providers failing to bill or refusing to bill Medicare for services covered.

Some Common Healthcare Fraud