Medicare Fraud — Definition, Examples, and How to Fight Back
Medicare medical fraud is a massive problem in the US, and taxpayers end up paying the price. But you don't need to sit idly by and watch this abuse happen. You can report Medicare fraud by yourself or use the DoNotPay app. The good news is that healthcare fraud can be prevented and reported, and DoNotPay is here to help.
This article covers the following:
- How much Medicare fraud is occurring in the US
- Types of Medicare medical fraud, like upcoding and unbundling
- How to report Medicare fraud by yourself
- How to report medical billing fraud using DoNotPay
Let's start with some numbers.
How Much Does Medicare Medical Fraud Cost?
Since Medicare is a federally-funded program, the cost of senior medical care is ultimately borne by taxpayers. Consider these statistics on Medicare fraud:
- The Centers for Medicare & Medicaid Services (CMS) estimates it paid more than $25 billion in fraudulent claims in 2020.
- Medicaid fraud was even more prevalent, costing taxpayers upwards of $86 billion in the same year.
- Part C Medicare fraud — claims made to private insurance companies — totaled $16 billion in 2020.
- And Part D fraud — that's for prescription drugs — cost US taxpayers $93 million.
We're looking at about $130 billion in one year! That's a hard number to wrap our minds around. Spelled out, it looks like $130,000,000,000.00.
How Does Medicare Medical Fraud Happen?
From the patient's perspective, there are two primary fraud risks:
- Identity theft or beneficiary number misuse occurs when a scammer or hospital staffer uses your benefits number to get healthcare services.
- Provider abuse can occur as upcoding or unbundling.
You must never share your Medicare beneficiary number with anyone other than medical staff, but even then, there is some risk. That's why you should always carefully read your benefits statements and medical bills. Make sure the program is only paying for services you receive.
What is Upcoding?
Upcoding occurs when a healthcare provider charges Medicare for more expensive services or a larger quantity of services than you received. For instance, if you go to the emergency room and endure three X-rays, but your hospital bills Medicare for five X-rays and an MRI, that would be upcoding.
Expensive medications can be upcoded, too. For instance, you might receive affordable generic medicines in the hospital, but they bill your insurance for the premium, brand-name item.
What is Unbundling?
Unbundling happens when a group of services are bundled together and charged to Medicare. For instance, if you’ve spent two hours at the hospital but get charged for a full day (including meals, cable TV, nursing staff, and so on), that's unbundling.
Reporting Medicare Medical Fraud on Your Own
If you suspect a provider is taking advantage of Medicare, you should report it immediately. Medicare offers a reward to the whistleblower when fraud cases are solved, but they don't say how much it is.
The table below explores ways to report Medicare fraud on your own. It can be a hassle, but it's not impossible.
|What to Report||What to Do|
|Medicare provider fraud||
|Medicare Advantage (Part C) fraud||
28464 Marlboro Avenue
Easton, MD 21601
DoNotPay makes it easy to report fraud. You don't need to hire an expensive attorney, and you don't need to spend hours on hold chasing hospital administrators to fix your bills. Use the app to get it done from the comfort of home.
How to Report Medicare Medical Fraud Using DoNotPay
If you're concerned that your insurance company or Medicare is paying for services you didn't receive, use DoNotPay. It's always fast, easy, and reliable. Just follow the five steps below.
- Search Fight Medical Fraud on DoNotPay.
- Tell us the date of your visit, what you were treated for, and where you were treated.
- Let us know what CPT code your visit was filed under. If you don't know, we'll generate a letter for you to send to your physician to request the code.
- Choose the correct CPT code or let us know if you want us to find it for you.
- And that's it! DoNotPay will automatically find the correct CPT code for your visit if you don't know it and then generate a demand letter on your behalf to send to your physician for a bill correction.
See how easy that is? You don't need to revisit the hospital, wait on hold for hours, or wait for a supervisor to call you back. Let DoNotPay handle this legal legwork for you. DoNotPay can write a demand letter for a bill correction, and if it does not get resolved, you can use DoNotPay's Sue Now product to start a small claims suit.
DoNotPay Is Your Personal AI Assistant
The app was initially created to tackle unfair parking tickets, and we've already helped hundreds of thousands of people like you. You can also use DoNotPay to:
- Write your advance health care directive
- File complaints against big organizations
- Help you request sick leave
- Get you assistance with your bills
Join us today to report medical fraud and request a bill correction!