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Medicare Fraud & Its Impact on Health Care

The federal government's Medicare insurance program helps elderly and disabled Americans pay for health-care services. However, numerous people have found ways to steal from the program by filing false insurance claims. Those fraudulent activities can put the health of Medicare recipients at risk and drastically reduce resources they rely on to receive health care.

  1. Defrauding Medicare

    • According to the Centers for Medicare and Medicaid Services (CMS), Medicare fraud involves intentionally falsifying medical information or deceiving the Medicare system. Doctors and medical suppliers may abuse the system by using Medicare coverage to charge for medical treatments or products that aren't necessary for the proper care of patients. CMS notes that a patient's complaint about the quality of care received from a doctor or hospital doesn't qualify as Medicare fraud or abuse.

    Medicare Costs

    • Scam artists have found numerous ways to defraud Medicare. According to a 2009 report aired by CBS on "60 Minutes," Medicare provides health care to 46 million people in the United States. However, criminals are stealing a portion of the half trillion dollars paid out annually in Medicare benefits. The "60 Minutes" report estimated that $60 billion a year is lost due to Medicare fraud. It's important for recipients to protect their Medicare account information to prevent fraud. One reason fraud occurs is that criminals are able to obtain the names and identification numbers of Medicare patients to bill the program for phony services.

    Dangerous Procedures

    • Some health-care providers put their patients at risk to cash in on Medicare and other health-care schemes. The National Health Care Anti-Fraud Association says some providers subject patients to unnecessary or dangerous medical procedures to collect payouts from health-care fraud. On its website, the association cites a 2002 case in which a Chicago cardiologist was sentenced to prison and ordered to pay $16.5 million in fines. The cardiologist was accused of performing 750 unnecessary heart procedures as part of a scheme to profit from health-care fraud.

    Medical Identity Theft

    • Medical identity theft is another problem connected to Medicare fraud. People who use another person's name to get medical services are committing medical identity theft. Such theft also involves misusing people's names to submit false insurance claims to collect payments. People who are targeted by medical identity thieves may receive the wrong medical treatment because incorrect information has been added to their medical records. Victims of theft also may find that their health benefits have been exhausted due to false claims.

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