Medicare Fraud "Epidemic"

Portland, Maine’s CBS affiliate WGME reported last week that the FBI is calling Medicare and Medicaid fraud a “national epidemic.” Unfortunately, it is an epidemic that costs Americans billions of dollars each year and diverts scarce medical resources from truly needed patients.

According to the FBI, healthcare fraud costs American taxpayers more than $80 billion per year and it’s getting worse.

A spokesperson from the U.S. Postal Inspection Service said, “Healthcare fraud is not a victimless crime. It’s costing taxpayers billions of dollars, but it’s also putting people at risk because people are getting unnecessary or possibly unsafe medical procedures that they don’t really need in the first place.”

Medicare fraud typically takes place in one of several ways:

First, someone bills Medicare for services that were not provided. We often see this scam take place with home health care agencies that bill for phantom services.

Second, someone bills Medicare for services that are different than what are received. An example is a medical clinic that bills for surgical sutures of a wound when actually, a nurse put a Band-Aid over a cut.

A third and common method of Medicare fraud is billing for services that are not medically necessary. We recently saw a cardiology practice performing unnecessary (and painful) stents on patients that didn’t need them.

There are, of course, many other methods. Every day, the Centers for Medicare & Medicaid Services, work hard to close loopholes yet criminals, greedy clinic operators and pharmaceutical companies invent new ways to pad their pockets.