When does Medicare fraud happen? Typically, this occurs when a health-care provider knowingly bills Medicare for goods or services that were not provided, or when a person uses someone else’s Medicare information to obtain goods and services they are not entitled to. Some beneficiaries may sell their Medicaid number to others who submit bills for health goods and services that were not provided. Medicare Fraud – Cost of Crime We all know what Medicare fraud is but did you know that recent statistics suggests that Medicare loses more than $60 billion per year because of this white collar crime? That amount of money would pay for almost half of all full-time college students in the country for a two year or four program! These scams are so lucrative they have even surpassed cocaine dealing as the major criminal enterprise in Miami, Florida. Because all scammers take pride in their work, they develop creative ways to pursue their ill-gotten gains, such as ambulance operators making phony trips, a fake pharmacy or medical clinic from a cheap office front, shipping unwanted penis enlargers to diabetes patients and billing for personal expenses such as jewelry, cars and vacations. Consider these behaviors Medicare fraud: Partially filling prescriptions, but charging as if a full prescription was provided. pay day loans instant approvalbest rated payday loans100 dollar loan no credit check Giving or accepting something in addition to normal reimbursement from a patient, other health care provider, or insurer in return for medical services. This is known as a “kick back”. videoidiotbootcamp.com/list/ Prescribing medications, drugs, or treatment that are not medically necessary. Charging Medicare or Medicaid patients a higher rate than others for the same prescription. Knowingly providing defective products or services. Falsely diagnosing a more severe ailment than the one the patient actually has. This is known as “upcoding” a diagnosis, thereby justifying a more expensive drug therapy or other treatment than that which the patient’s health requires. Inappropriate changes in patients’ prescriptions from one drug to another as a result of kickbacks or for other improper reasons. Paying beneficiaries with no health problems to make unnecessary visits. Fabricating claims from nonexistent clinics, patients or deceased patients. Changing a diagnosis or treatment code to secure a higher reimbursement. Billing for services not actually performed, known as “phantom billing”. Embezzlement of recipient funds. Billing more than one services that should be combined into one. This is known as “unbundling”.  Fighting Thieves So how do we fight them? Various vendors have developed software for identifying several indicators of fraud. These systems can identify providers who consistently submit questionable claims, it recognizes patterns within individual claims, without reference to the provider, which immediately stops the claim for...