Elderly individuals rely heavily on their medical insurance to provide them with affordable healthcare. If this coverage is compromised, the cost can quickly become astronomical.
Medicare is the largest insurance carrier for elderly patients. However, it’s also the most susceptible to fraud. Here’s what you should know about Medicare fraud and how to get legal assistance from a seasoned consumer protection lawyer.
What Is Medicare Fraud?
Medicare fraud happens when a person or entity willfully defrauds Medicare in order to obtain funds when they are not entitled to them or to earn a larger payment than they are entitled to.
Anybody, including physicians, other healthcare providers, and even beneficiaries can engage or be complicit in Medicare fraud. As with most types of fraud, this is assumed to be committed knowingly or with criminal intent.
The Centers for Medicare and Medicaid Services (CMS) describes Medicare fraud as “intentional deception or misrepresentation that the individual knows to be false or does not believe to be truthful,” and is committed “knowing that the deception could result in some unauthorized benefit to himself or another person.” Medicare fraud is against the law and should be reported to governing authorities.
Examples of Medicare Fraud
Here are several examples of what Medicare fraud might look like:
- Billing for medical services never provided. A medical practitioner sends the patient a bill for a test they never performed, e.g., an additional blood test that was not run at the time the patient had blood taken for other reasons.
- Performing unnecessary procedures. A medical provider recommends services or procedures to patients who don’t need them, e.g., more extensive testing for a patient whose health has not changed in any meaningful way from their previous visit.
- Sending and billing for unsolicited products. A healthcare professional sends a patient new products or samples as what appears to be a special courtesy, when the practice sends Medicare the bill instead.
- Falsifying dates medical services were provided. A medical provider changes the dates of service to get around insurance regulations, such as billing for services on different days that were actually provided the same day if the patient’s insurance only covers so much per day.
Ways to Protect Against Medicare Fraud
Prevention is arguably ideal where Medicare fraud is concerned; cleaning up the mess afterwards is often much more difficult than simply taking precautions right out of the gate. Here are some ways elderly individuals can protect themselves against Medicare fraud:
- Keep your Medicare card safe. Do not give your Medicare card to another person unless they are a healthcare provider, a close family member helping to take care of you, or another person you know should have it.
- Protect your identity online and in person. Do not give out identifying information about yourself to other people. Protect your social security number, your last name, your birthdate, and any other information that can be used to falsify your identity and obtain healthcare services under your name.
- Track your doctor’s appointments, prescription refills, etc. Consider keeping a calendar on hand to specifically track your medical appointments, prescription drug refills, and other important transactions. If you receive a bill or a statement from Medicare saying you received a service on a particular day, you can go back to your calendar and make sure it was something you did.
- Do not accept gifts, free offers, or other no-cost healthcare products or services. Free medications, medical devices, sample products, and similar items may not actually be free. The practice or other entity providing these may be charging your health insurance for the products or services and writing off whatever your insurance doesn’t pay. This can be problematic if they exceed your coverage limits.
- Learn about current Medicare scams and fraudulent activity from the Federal Trade Commission (FTC). The Federal Trade Commission’s website is a great resource for information on the latest scams and fraudulent activity that Medicare and other related entities are aware of. By staying up to date on current scam strategies, you can identify potential fraud sooner and protect yourself more effectively.
How a Consumer Protection Lawyer Can Help
Medicare fraud is the most common type of fraud committed against the government. According to the U.S. Department of Justice (DOJ), a round 10% of Medicare and Medicaid charges are exaggerated or falsified. As many as 80 prosecutors are solely assigned to discovering and prosecuting Medicare and Medicaid fraud in the agency’s Health Care Fraud unit.
Because of this, the DOJ offers significant rewards for whistleblowers. You may be eligible for a whistleblower award if you help them identify Medicare fraud. A consumer protection attorney can assist you and can also help provide you with legal protection should the accused attempt to take action against you.
Additionally, an experienced lawyer can help victims of Medicare fraud stop the scam at its source and recover damages for any financial losses they incurred as a result. Medicare fraud can be costly for beneficiaries and you should not be responsible for these expenses due to the criminal activity of someone else and no fault of your own.
Call Mazow | McCullough, PC Today
If you or a loved one were the victim of Medicare fraud or a Medicare scam, it’s important that you act as quickly as you can to protect your rights and best interests. The experienced consumer protection attorneys at Mazow | McCullough, PC can help you.
Contact us today to schedule a consultation by calling our office at (978) 744-8000 or toll free at (855) 693-9084. We are available now to answer your questions, address your concerns, and take aggressive legal action on your behalf.