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Medicare fraud


While most of the doctors as well as other health care providers, suppliers, and private companies are honest, there are still a few of them who are not. In the same light, some health care services buyers or consumers also commit Medicare fraud either advertently or inadvertently.

It can then be said that even though it is only a small percentage of health care providers and consumers that deliberately engage in health care fraud, that small amount of health care fraud is capable of raising the cost of health care benefits for everyone. But what exactly is Medicare fraud? This among other things is what will be discussed in this article.

Medicare fraud is committed when someone dishonestly submits or causes someone else to submit, false or misleading information for use in determining the amount of health care benefits payable. This crime can be committed by a dishonest health care provider or consumer.

Examples of Medicare Fraud range from, when a health care provider bills health care agency for services that was never received, medical equipment that was never got, using another person's Medicare card to get health care benefits, supplies or equipment, billing health care agency for home equipment after it has been returned, offering drug plan that has not been approved by the agency and using false information to mislead someone into joining a Medicare plan.

Effects of Medicare Fraud

Medicare fraud affects every citizen. It constitutes an economic excess; and waste, fraud and abuse take critical resources out of a nation's health care system, and contribute to the rising cost of health care for all citizens.

By eliminating fraud, costs for families, businesses and the federal government will be drastically reduced thereby increasing the quality of services for those who need health care.

How to avoid Medicare Fraud

Here are some easy ways to protect you from Medicare fraud and keep health care costs low for everyone:

•  Always ask questions about the services you receive. Your questions may range from what are the services meant to do? Why are they needed? What cost is involved? etc.

•  File one claim form at a time.

•  Question advertisements or promotions that promise free tests, treatment or services. Be careful with the type of personal information you give out, especially when the provider requests your insurance information or a copy of your Medicare ID card. Remember your ID card represents your benefits.

•  Compare your medical bills with your records; ensure everything correlates correct dates of service, actual services performed, etc.

•  If you run managed care coverage, if there is any charges exceeding your copayment that you are asked to pay by a provider, ask question and be sure you get the right answer.

Report any suspected fraud to Special Investigations Department.

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