I know some of you are wondering what Medicare Fraud is and what happens. But I am her to give you some information on what it is, and what Medicare abuse is and also some examples for both of those.
To protect the organization you will need to look for a few things.
- Examples of Medicare fraud and abuse.
- Overview of the laws used to fight fraud and abuse.
- Descriptions of the partnerships among government agencies engaged in preventing, detecting, and fighting fraud and abuse.
- Resources on how you can report suspected fraud and abuse.
What is Medicare Fraud?
- Knowingly submitting false statements or making misrepresentations of fact to obtain a federal health care payment for which no entitlement would otherwise exist.
- Knowingly soliciting, paying, and/or accepting remuneration to induce or reward referrals for items or services reimbursed by Federal health care programs.
- Making prohibited referrals for certain designated health services.
Examples Of Fraud
- Knowingly billing for services not furnished, supplies not provided, or both, including falsifying records to show delivery of such items or billing Medicare for appointments that the patient failed to keep.
- Knowingly billing for services at a level of complexity higher than the service actually provided or documented in the file.
What is Medicare Abuse?
Abuse describes that, either directly or indirectly, result in unnecessary costs to the Medicare Program. Abuse includes any practice that is not consistent with the goals of providing patients with services that are medically necessary, meet professional standards, and priced fairly.
Examples of Abuse
- Billing for services that were not medically necessary.
- Charging excessively for services or supplies.
- Misusing codes on a claim, such as up coding or unbundling codes.
If you are wanting more information about Medicare fraud and abuse then you can either feel free to give me a call at 901-KORTNI8, or you can Click here.