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Definition of Medicare Fraud

Medicare fraud occurs when services that were never received or provided are purposely billed. For instance, Medicare cannot be billed for a major surgery when a patient only receives a bandage to cover a minor cut or injury.

  1. Who Commits Fraud

    • Medicare fraud typically occurs in nursing homes, hospitals, residential facilities, hospice and other health care providers.

    Effects

    • Providers who are convicted of committing Medicare fraud are excluded from receiving funds from a federally-funded health care program for a minimum of five years.

    Prevention

    • State and federal agencies (such as the Department of Justice and the Federal Bureau of Investigation), Medicare providers (including physicians and suppliers), the Centers for Medicare and Medicaid Services, and people who use Medicare all work together to help prevent Medicare fraud.

    Warning

    • A Medicare beneficiary should be warned that it is fraud if he sells his Medicare number to someone that billed Medicare for services not rendered, provides his Medicare number in exchange for money or gifts, or lets someone use his Medicare card to get supplies, medical care or equipment.

    Potential

    • The people who follow the rules and regulations of Medicare potentially face higher premiums due to those who take money from the Medicare program by committing fraud.

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