If you have information about a health care provider committing fraud on Medicare, you have a choice if you will just turn a blind eye or become a whistleblower. Because of whistleblowers, federal and state governments have been able to recover billions of dollars lost because of fraud.
Every year, billions of dollars are lost to scammers because people choose to simply shut up and take little care. What people should learn about is that the government rewards whistleblowers with around 15% to 30% of the total amount of dollars recovered.
Health care providers who commit fraud, do it in several different ways and responsible citizens who witness this need to report the crime to the proper channel. The most common type of fraud is charging for services that were never rendered and supplies that were not even used. This type of fraud is the most commonly committed one by scammers.
Medicare only reimburses services and supplies that are medically necessary. In order for Medicare to determine if services or supplies being charged are necessary, they have to verify the claim by referring to doctor’s prescriptions and recommendations. Fraud is committed when health care providers falsify these documents just so they could charge Medicare.
Most of the procedures and supplies that are billed to Medicare are identified via codes. Each code has a corresponding charge as well as service that was rendered. Fraud happens when more expensive codes are submitted and charged to Medicare instead of the real ones. This type of fraud is called upcoding. Unbundling works differently though because instead of being charged together services are unbundled and charged via separate codes which definitely cost more. Some services are meant to be charged in a bundle and when services are unbundled, codes are much more expensive.
There are pharmaceuticals and medical devices that needs certification and approval by the FDA first before they can be sold off in the market. Medicare does not reimburse for items like these because techinically, its illegal to sell them yet. Some companies promote for the non-approved or off label uses of their products. This becomes fraud when health care providers charge Medicare for these pharmaceuticals or medical devices. In order to be a whistleblower, there are pages online dedicated to Medicare fraud reporting. If you prefer phone calls, you can dial the Medicare fraud hotline.
The country loses billions of dollars every year because of Medicare fraud. Go to this page for more information on medicare fraud hotline