Medicare is a federal health insurance program in the United States for people age 65 or older and younger people with disabilities, which makes it one of the most important government programs in the country. While there are many efforts made to keep the program not just afloat but also free of any suspicions or fraud, sometimes things can fall through the cracks and it can be up to citizens to report any malfeasance that they discover.
Especially nowadays with the increase in cost of living and healthcare costs it is key so save any possible dollar for treatment and not spend it on deceptive practices. Adding to that the fact that the program is perpetually underfunded and overextended because of the increase in the eligible population to participate in it, it has become more important than ever to protect Medicare from those who would abuse it.
Medicare abuse, what forms it takes and how to report it
We tend to think of fraud as something that beneficiaries commit in order to get more benefits, and while this could be the case in certain instances, in the case of Medicare it is much more common that it is the doctor or the office that they are based on is the one that is overbilling the program.
Fraud can take many shapes and sizes, and while fudging the codes to ensure that patients get better care can be a problem, it is much more common for the program to be billed for outright fake claims or procedures that never took place, especially when it comes to the elderly or people with impaired cognitive function who may not be as aware of what is in their chart or what each procedure entails.
While some things may seem innocuous, especially if they are done under the guise of helping patients and improving their care, the reality is that all these add up and can lead to abuse of the system which can then translate into substandard care or investigations that lead to even more waste of money.
The first thing you need to do both to prevent and to report fraud is to ensure that you understand why you are in the doctor’s office and what the diagnosis and course of treatment is. What specialists did you see? What procedures did you get? Who came into your room and for what? What was that consult for? Why was that test ordered? These are all questions that may not make you very popular with irresponsible medical professionals, but will really help you when it comes to being aware of your treatments and financial obligations. A small piece of advice is to always try to have another person in the room that can ask more questions or back up your account of the situation.
Ask for a copy of your charts and review them, also compare your appointment calendar with the statements that you receive to ensure that there are no duplicates, mistakes or straight up made up appointments. Always make sure to remember if you cancelled an appointment and do not give your Medicare or Social Security numbers to anyone except trusted providers.
If you suspect that there is something wrong or that you have been billed incorrectly, report it to the correct authorities, dispute any bills that do not look legitimate and any charges for procedures that you know were not performed on you or consults that you did not authorize or need. Always contact your provider first, preferably by email to leave a paper trail and if the answer is not satisfactory or the charges seem intentional, report it to Medicare directly.