Preventing Fraud and Abuse in the Medicare Program

Prevention of fraud and abuse is a key component of the Medicare program. While many of these crimes are not criminal, they do pose a risk to health care providers. Some of the most common types of fraud and abuse involve the improper use of the Medicare system. These acts include false billing, upcoding, unbundling, and using someone else's insurance coverage. This article provides tips to help providers avoid these problems.

Health care fraud is a growing problem that puts patient trust in jeopardy. The results of these medical procedures are often permanent and often require significant invasive treatments. In many cases, the resulting complications could endanger the patient's health or physical mobility. Recently, a leading cardiologist in Ohio was sentenced to 20 years in prison for fraudulently billing Medicare for 29 million visits.

Top Fraud and Abuse in the Medicare Program

Increasing awareness of healthcare fraud is a critical step toward preventing it. With Medicare's value-based purchasing model, providers are seeing their claims reimbursement rates fall in favor of incentive payments. This may push providers to commit fraud in order to maximize revenue. Some providers may not correct billing clerks who incorrectly assume they performed services, and others may be coordinating with other provider organizations under a value-based agreement. These actions can cause the Medicare program to suffer financially.

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