The Office of Management and Budget has been made efforts to limit Medicare fraud, but Medicare’s complexity makes it an easy target for fraud. “It’s like playing the lottery for those who are intent on defrauding the government, but with a much higher chance of a payoff,” he wrote.
In his column, Dr. Roberts outlines three major categories of Medicare fraud: phantom billing, false patient billing, and upcoding/upbilling.
Here are three takeaways from his column.
1. Dr. Roberts said phantom billing occurs when a provider bills Medicare for unnecessary or unperformed services. “Billing for medical equipment falls under this category. I see this type of fraud frequently when companies bill Medicare for equipment or services for my patients that they never requested or that I did not prescribe,” he wrote.
2. False patient billing, Dr. Roberts said, occurs when providers bill for services that weren’t provided or that were not necessary, without showing obligation to pay. “Sometimes Medicare patients will even participate in this scam by receiving monetary kickbacks from companies by providing their Medicare numbers so the companies can bill for services that were never performed,” he wrote.
3. Lastly, Dr. Roberts examined upcoding or upbilling, which he said involved a provider of services uses a billing code “that will result in a higher level of payment from Medicare for the service provided or may lead to the need for additional services.”
More articles on finance:
7 recent RCM product launches
Change Healthcare adds capabilities to SmartPay app: 3 things to know
Medicare’s top 15 costliest drugs in 2015
