Medicare Fraud

Medicare fraud is a general term that refers to an individual or corporation that seeks to collect Medicare health care reimbursement under false pretenses. Common forms of Medicare fraud include:^[1]

• 1) Services not rendered
• 2) Upcoding schemes and Unbundling
• 3) Kickbacks and Self Referrals
• 4) Falsely Certifying and Giving False Information
• 5) Lack of medical necessity
• 6) Fraudulent Cost Reports

Additional recommended knowledge

Daily Visual Balance Check

Daily Sensitivity Test

Essential Laboratory Skills Guide

Those responsible for reporting Medicare fraud include:^[2]

• 1) The Centers for Medicare & Medicaid Services (CMS)
• 2) People with Medicare
• 3) Providers of Medicare services including physicians, providers, and suppliers
• 4) State and Federal Agencies such as, the Department of Health and Human Services Office of the Inspector General, the Federal Bureau of Investigation (FBI), and the Department of Justice.

See also

• False Claims Act

References

1. ^ http://www.warrenbensonlaw.com/medicare-fraud.jsp
2. ^ http://www.medicare.gov/FraudAbuse/Overview.asp