Fraud Involving Medicare And Medicaid
Unfortunately, fraud against government programs has been a constant concern throughout American history. However, legislators have created a number of programs and laws to protect and reward those who report and expose any individual who is committing any fraud against the government. Below, we answer some common questions about fraud against these health care programs.
What is Medicare/Medicaid fraud?
It refers to the actions performed by a third party to gain unlawful access to health programs and reimbursement for medical services by providing false information. Fraudsters, for example, may steal a beneficiary’s identity or Social Security number to use Medicaid or Medicare services they would otherwise not be entitled to.
What are some examples of types of Medicare or Medicaid fraud?
- Drug diversion, which consists of altering a prescription to obtain more of a drug to sell it to others
- Sharing a Medicaid/Medicare ID card so an individual other than the beneficiary may have access to the program
- Collusion, which refers to knowingly filing false claims to obtain reimbursement in collaboration with a physician
Who gets hurt in these fraud cases?
Fraud can increase the cost of Medicare or Medicaid services. Sometimes, Medicare or Medicaid beneficiaries are unaware that their information was stolen. When perpetrators access an individual’s medical information, the original beneficiary’s medical record will include the imposter’s medical information as well, which could lead to a misdiagnosis or other medical problems.
How do you discover Medicare or Medicaid fraud?
As a beneficiary, you should record all your medical appointments, diagnoses and prescriptions. If you notice additional activity, report it to the Medicare and Medicaid toll-free numbers. If you are a contractor or work for a company or health provider related to these services, seek legal advice and learn your rights to report your employer’s fraudulent activity.
Are there rewards for reporting fraud?
Yes. Under the False Claims Act, individuals who report illicit actions against the government may be entitled to receive from 15% to 30% of the damages recovered by the government if the case is successful. This can be a significant amount. For example, according to United States Department of Justice statistics, the government recovered $2.2 billion in September 2020.