5 Types of Medicare Fraud and What To Do If You're a Victim

Fight Medical Fraud 5 Types of Medicare Fraud and What To Do If You're a Victim

5 Types of Medicare Fraud and What To Do If You're a Victim

When most of us think about our doctor or our chosen medical facility, we don't think about deception. However, many doctor’s offices are playing a game with insurance companies which means they are committing Medicare fraud. You should arm yourself with knowledge by knowing the common types of Medicare fraud, and how to ensure that your insurance isn't being affected.

To ensure you know what to look for with your own insurance charges, DoNotPay is here. We can help you discover the many types of fraudulent activity, things to look for, and what to do about it if you suspect a problem.

What Are Medicare Frauds and Why Should I Care?

From the outside looking in, medical fraud may seem like just a simple way for your doctors to pad their pockets a little. It may seem like something your insurance company or the government must deal with rather than you. However, this is far from the truth.

Much the same as other types of fraud or scams, health care fraud can pose risks to you and others. It can cause a chain reaction of things to happen, including

  • Increased Health Insurance Premiums
  • Increasing Taxes to Cover Medicare Costs
  • Puts You at Risk for Unnecessary Procedures
  • May Cause Other Doctors to Skip Vital, Life-Saving Tests

It is also important to understand that fraud of this type isn't just something doctors do to get money. Anyone can commit it. Patients, medical professionals, and facilities can all contribute to a lack of good care for you.

Types of Medicare Fraud

There are many types of Medicare fraud. Some involve billing discrepancies, while others can negatively affect how you're treated.  The most common discrepancies and examples of each include:

1. Double Billing

When a doctor double bills your insurance company, it means that they charge you twice for the same services. For instance, they may claim that you were in their office and under their care on two or more consecutive days.

2. Phantom Billing

Phantom billing is a little different. It means that the doctor may charge you for tests and procedures that you never actually had done. This may include blood draws, office visits, x-rays, or other things.

3. Upcoding

In the medical system, procedures and office visits are listed as codes. Overall, there are about 7,800 active codes currently being used. This is one of the biggest examples of committing fraud with Medicare. By changing one digit in the code, your doctor can increase or decrease the amount of money he may make from your insurance company. This is called upcoding because it may make your existing patient visit appear to be a new patient visit, which gives your doctor a bigger payday.

Sometimes, the mistake may have been done in error. In this case, if you happen to see that there is a discrepancy, and you contact your doctor, they will attempt to fix the issue. If they were attempting to get more money, they may ignore your concern.

4. Unbundling

Like upcoding, unbundling has to do with CPT codes and how the doctor writes up what they have done for you. When unbundling, your doctor will attempt to bill insurance separately for a service that should be bundled with something else. One example would be a surgical procedure that requires you to be in recovery afterward. The two things may be linked because we assumed you will need to recover after surgery. By billing separately, your doctor might increase his profit.

5. Other Shady Practices

Most people want to have more money in their pocket. Your doctor also likes money. They may try to push drugs from pharmaceutical companies that you may not actually need to get money from both Medicaid and those companies. Doctors may also provide services, run tests you don't need, or fail to document the things that they find when you need testing.

The list of ways that a doctor can try to skim off the top is limitless. Therefore, it is important that you learn now how to protect yourself in the future.

How to Protect Yourself and Your Information

By understanding how common is Medicare fraud, you can better protect yourself from it. Some things to consider if you are trying to protect yourself are:

  1. Do You Protect Your Medicare Number? This means you should avoid sharing it with friends, family, or anyone other than your chosen physician's office.
  2. Do You Avoid Door to Door Sales Associates Asking for Medical Information? Medicare or other insurances will never send people to your home who represent medical supplies, sales, or services.
  3. Do You have Multiple Medicare Cards Lying Around? To protect yourself, shred those old cards you have in the same way that you would get rid of an old bank account card.
  4. Do You Know When You Went to the Doctor Last, or What They Did to Provide Care to You? By keeping track of your appointments and other information, you can spot issues with your Medicare statement much easier.
  5. Do You Feel Pressured to Take a Medicine? If you're uncertain of why you are taking a specific medication, it may be time to do a little research for yourself to find out why your doctor feels you need it.

When fighting back against and reporting medical billing fraud, knowledge is your only power. You should know before you begin, that it sounds easier to do than it is.

How to Report Medicare Fraud on Your Own

It is everyone's responsibility to fight back against fraud, whether medical or otherwise. Now that you know the types of Medicare fraud, it is also important to understand who to contact if you suspect an issue.

The first step is to contact your physician to ask about errors. This will ensure you do not end up filing a false claim against an honest doctor. If this does not produce results or your charges remain standing, then you have several options. You can contact any of the following:

Your State’s Health Department or the U.S. Department of Health and Urban ServicesSubmit a Hotline Complaint | Office of Inspector General | Government Oversight | US Department of Health and Human Services
Medicare OfficeReporting Medicare fraud & abuse
Centers for Medicare and Medical ServicesReporting Fraud | CMS

We recommend going down the list until you find an entity that you can trust to help you settle any discrepancies when you report Medicare fraud. It will not be a simple process, and you may need to invest a lot of time to do it.

DoNotPay Can Take the Pressure off When Reporting Medicare Fraud

Medicare and medical fraud are big deals. Even though the cost may not come out of your pocket, you must avoid letting it slide. However, the process is daunting for some people.

This is where DoNotPay comes to the rescue. We can contact your doctor with demand letters to encourage them to change their billing, or we can take it to the next steps. With DoNotPay’s Sue Now product, we can help you begin a small claims lawsuit against the hospital/health care provider. All you must do is complete five very easy steps, and we will take care of everything else.

To get started, you only need to:

  1. Search Fight Medical Fraud on DoNotPay.


  2. Tell us the date of your visit, what you were treated for, and where you were treated.


  3. 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.


  4. Choose the correct CPT code or let us know if you want us to find it for you.


  5. 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.


What More Can DoNotPay Help You With?

The goal of DoNotPay is to make life simpler for you. We help you learn about the types of Medicare fraud and know what to look for to ensure you’re protecting yourself and that your insurance is not affected.

We can also help you find out what you need to know about:

When trying to lower your stress level, DoNotPay is a great tool to have in your toolbox. To get the help that you need, for any challenge you are facing, simply visit DoNotPay online. We will do our part to make it easier.

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