One stolen Medicare number can lead to months of improper billing, and while losing money is problematic enough, this can also ruin your medical record. Medicare fraud can also delay care when you need it or cause complications with taxes and billing. In order to protect yourself, you will need to familiarize yourself with what the law considers Medicare fraud.
What is Medicare fraud?
Medicare fraud is the intentional deception of the Medicare program by providers or individuals to receive payment without authorization. Bear in mind that Medicare is a federal program, which means federal law drives most enforcement, even when the conduct occurs in Texas.
Under 42 United States Code Section 1320a-7b(b), it is against the law to offer or receive payment to induce referrals for services that federal healthcare programs provide. This discourages fraud in health care benefit programs such as Medicare.
Examples of Medicare fraud schemes in Texas
Many scams start with phone calls, online ads or offers of “free” items. If someone pressures you to share your Medicare number or promises something for nothing, you should pause and verify the source. Some common examples of fraud include:
- Billing for services you never received. You see charges for office visits, lab tests, therapy or home health services that you did not receive or ask for.
- Unnecessary equipment or supplies. A caller pushes braces, genetic tests, catheters or diabetic supplies you do not need, then bills Medicare after a brief or nonexistent consultation.
- Upcoding. A provider bills Medicare for a more complex or expensive service than the one you actually received.
- Kickbacks. Someone offers you cash, gift cards or other benefits in exchange for your Medicare number or for using a specific clinic, lab or supplier.
- Sham telehealth visits. A short call, or no call at all, leads to claims for telehealth services or to orders for equipment and tests.
You can reduce the risk of becoming a victim to Medicare fraud by reviewing your Medicare Summary Notice and comparing it to the care you receive. If you find mismatching or incorrect charges, you can report to Medicare or the HHS Office of Inspector General.
In Texas, Medicare fraud often involves false billing, unnecessary equipment schemes, upcoding, kickbacks and sham telehealth claims. You can help protect yourself by keeping your Medicare number to yourself, reviewing your statements carefully and reporting suspicious activity to the relevant agencies and authorities as soon as possible.