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What are the different types of Medicare fraud?

On Behalf of | Feb 11, 2022 | Medicaid/Medicare Fraud |

Being accused of Medicare fraud is a frightening prospect for any New York health care professional. It’s important to understand this type of white-collar crime and its different types.

What is Medicare fraud?

Medicare fraud is a crime that involves fraudulent activities taking place in the Medicare health system. Usually, doctors or medical offices might be accused of this white-collar offense, but sometimes, others could face charges as well.

What are the most common types of Medicare fraud?

There are many different ways that Medicare fraud can occur. A health care professional could be guilty of the crime by double billing for a service that was only performed once. The opposite situation, phantom billing, is also common. It occurs when Medicare is fraudulently billed for a service that a patient never actually received.

Unnecessary services performed on patients in order to benefit from compensation is another common type of Medicare fraud.

Upcoding relates to changing billing codes for specific Medicare services to show that a higher level of service was performed than what was actually performed. This is a common type of Medicare fraud that is used when the perpetrator aims to get a higher reimbursement than they deserve.

Kickbacks are common with Medicare fraud. The medical provider accepts payment on behalf of a medical device supplier or pharmaceutical company for prescribing their products to patients.

When a health care provider or medical office deliberately misleads by using improper documentation for services rendered, it’s a popular form of Medicare fraud. Another common type of Medicare fraud involves filing claims for patients ineligible for the insurance.

Another form of Medicare fraud occurs when a patient is prescribed medications they don’t need or over-prescribed medications they do need. This can result in an overdose.

Being accused of Medicare fraud can have serious consequences. If you’re innocent, fight back to protect your rights.


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