Healthcare Fraud and Abuse: What Should You Look For?

The elderly population is a target for many forms of abuse, including emotional, physical, and financial. In addition to this, James of Durham, North Carolina, has discovered just how important it is to protect your senior against healthcare fraud. Medicare fraud, in particular, is something that takes place every day and few seniors may notice it.

James highly recommends learning the different types of Medicare fraud that can occur to best protect your elderly loved one. His mother was abused in this manner and, since discovering the situation, he was worked to help bring awareness to this form of mistreatment. Here are, according to Forbes, six different kinds of Medicare related fraud to which your senior may fall victim:[1]

1. Identity Theft: Dishonest medical professionals have access to sensitive records. As such, they may steal information and over-bill the Medicare program, thereby making a profit for themselves.
2. Fraudulent Equipment Billing: Medicare may receive a bill for new, more expensive equipment, but your senior may be given older resources.
3. Phantom Billing: Doctor's offices engage in this form of fraud when they bill the Medicare program for services that were never rendered.
4. Upcoding: Each service has a code that is reported, and this code is what Medicare uses to determine the payment the doctor receives. By submitting codes for services that are more expensive than those provided, offices can collect more money.
5. Recommendation of Unnecessary Procedures: Even if a test is not needed, a doctor may conduct a procedure for the sole purpose of collecting the Medicare reimbursement on it.
6. Prescription Fraud: Dishonest doctors may provide patients with generic drugs while charging Medicare for more expensive name brand pharmaceuticals.

James knows that Medicare fraud is a more prevalent issue than you might first assume. As such, he encourages you to be on the lookout for signs of fraudulent activity and report anything that you detect to the proper authorities. By reviewing your senior's claims, comparing doctor's records with Medicare documentation, and going over your senior's Medicare Summary Notice, you can ensure that your elderly loved one is receiving the services for which their doctor's office is charging.

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[1] http://www.forbes.com/sites/bernardkrooks/2012/10/04/seniors-need-to-be-wary-of-medicare-fraud/