The Baby Boomer Renaissance: Consumer Boomer

Wednesday, September 15, 2010

Consumer Boomer

How to Avoid Medicare or Health Care Fraud

Posted: 15 Sep 2010 05:37 AM PDT

Health care is expensive enough without worrying about an increase in the cost of services or products as a result of health care or Medicare fraud. When a person or company attempts to “rip off” the health care system all patients end up paying the cost. But what happens if you make a mistake that could be considered fraud? Or, your health care provider is responsible for information that was incorrectly submitted to Medicare or your insurance company. Here we look at health care fraud as well as prevention and detection tips.

photo credit: wstera2

What is health care fraud?

To avoid or detect health care fraud, it is important to first understand what actions are considered fraudulent. As a general rule, fraud has taken place when an insurance company or Medicare is billed for products or services that were never provided. This may include but is not limited to:

Charging for medical equipment that has been returned.
Charging for services or products that you either never received or items that were different from those your received.
Using the insurance card or Medicare card of an individual other than yourself to receive care, products or services.

Basically if you or your health care provider bill another party for items that were either not received, received and returned, or received but different from items ordered, fraud is being committed.

Detection and prevention tips of Medicare fraud.

As health care costs continue to skyrocket, fraud must be a concern for everyone. You should be suspicious if any of the following actions take place:

Your health care provider tells you the service or product is free and they only need your Medicare number for their own records.
Your health care provider encourages you to go to health clinics or offices in return for payment.
You are told that the more tests that are conducted, the less expensive they will cost.
Your health care provider ensures they know a way to get Medicare to cover an expense.
You are rarely if ever asked to pay a co-payment unless you are receiving prevention services that are Medicare covered.
Your provider bills Medicare for tests or services you have not received.
Your health care provider advertises and offers free consultations to individuals with Medicare.

The above mentioned scenarios should raise a red flag that something is not on the up-and-up with your provider and their billing practices. To prevent health care fraud, you must be diligent in reviewing any statements you receive from Medicare or your insurance company. Look closely at the charges and confirm if you received all of the tests, services or products for which they have been billed. If the information is correct, report the error immediately. While accidents may happen and it is possible for the wrong information to be entered, it doesn’t occur on a regular basis. If this is the case, it is time to change health care providers to ensure you are not a part of Medicare or other instances of health care fraud.