Medicare open enrollment season, which runs between October 15 – December 7, 2017, is fast approaching. During this time thousands of Americans will be applying for benefits. While Medicare and Medicare Advantage offer benefits to millions of people, fraud and abuse are two issues that adversely affect Medicare and the people who depend on it. In fact, a 2015 report found that as much as $60 billion was lost through Medicare fraud in 2014.
In this three-part post, we will take a close look at health insurance fraud and abuse, how they happen, and what you can do to prevent them. In this first post, we will explain what Medicare fraud and abuse are and, more importantly, why they matter.
What Is Medicare Fraud?
To put it simply, one type of Medicare fraud occurs when someone knowingly makes a false claim for services and procedures that never happened. That means your doctor or another party is charging the Medicare system for services never rendered. Because health care providers are reimbursed by the government for treating Medicare patients, it is a potentially lucrative form of fraud that costs taxpayers billions every month. We will dive deeper into the types of Medicare fraud in post two.
What Is Medicare Abuse?
Medicare abuse is a little different. One example is when a doctor administers treatments or procedures that do not truly benefit a patient. These procedures can range from unneeded but harmless prescriptions to potentially deadly surgeries. In this case, work is being performed by the doctor, but the work was not necessary. Medicare abuse exposes patients to unnecessary risk.
Why Should Anyone Care?
People seem to care more about Medicare abuse because it can have a negative impact on a person’s life, even resulting in death. But fewer people seem worried about Medicare fraud. All too often, it’s seen as a victimless crime. That simply isn’t true. As tax payers, it’s your money being stolen and wasted.
Plus, every unnecessary cost to Medicare results in an undue burden on the Medicare system as a whole, which then results in higher premiums and health care costs for everyone who relies on the program.
That’s why Medicare fraud should be a concern for every American, whether they pay for private insurance or are on Medicare. In the next post, we will examine the most common methods of Medicare fraud and abuse.
Sources:
ABC News, “Medicare Funds Totaling $60 Billion Improperly Paid, Report Finds,” July 2015
Medicare Consumer Guide, “Preventing Medicare Fraud”
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