Medicare Fraud and Health Insurance Fraud

 In Blog Posts

Medicare Fraud and Health Insurance fraud is at an all-time high – with criminals not only bilking government funded and regulated programs out of billions, but stealing from individuals as well. You have to arm yourself by checking your monthly statements every month, and calling your insured immediately (and following up with a detailed letter) if you notice any changes that you have not authorized. Of course, a huge concern is someone else utilizing your information for services which YOU will be held financially responsible.

On a larger scale, Medicare fraud has been recently investigated on CBS news’ 60 Minutes. Medicare, which provides services for almost 50 million citizens of the United States, according to the televised report, has become possibly the most profitable crime in the country – causing upwards of 60 billion dollars a year in fraudulent activity. One of the problems is that there are so few government workers for sufficiently check everything coming into their offices. It’s almost like one football team with the standard 11 players on the field, and the other with merely 5.

Common ways that criminals commit Healthcare fraud:

  • Billing your insurer for institutional facilities such as hospitals, rehabilitation services, nursing homes, and residential facilities,
  • Billing for bogus physician and hospital visits and services.
  • Billing for medical equipment such as braces, prosthetics, wheelchairs, incontinence supplies or diabetic supplies.
  • “Phishing” schemes such as marketing with phone calls, door-to-door sales and flyers – which generally promise “free” services or items, and are used as bait to get your name and insurance identification.

The FBI has a very informative page on how to avoid becoming a victim of insurance fraud – and here are some of the highlights:

  • Never sign blank insurance claim forms – this is a “blank check” for a criminal.
  • Never give blanket authorization to a medical provider to bill for services rendered (see above!).
  • Ask your medical providers the charges, and what your out-of-pocket charges will be.
  • Carefully review your insurer’s explanation of the benefits statement. Call your insurer and provider if you have questions.
  • Do not do business with door-to-door or telephone salespeople who tell you that services of medical equipment are free – this is just a way for them to get your information to use later.
  • Give your health insurance and Medicare identification only to those who have provided you with medical services.
  • Keep accurate records of all health care appointments – and best yet, scan them into your computer, and back up with a storage saving device such as Carbonite.
  • Always check your insurance and physician bills and statements for equipment and services ordered on your behalf.

If you suspect fraud being committed in your name, and you are being requested to pay and/or reimburse, contact the offices of Cohen and McKeon to discuss this serious matter.



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