What is Medicare Fraud?

Medicare fraud occurs when a hospital, nursing home, doctor's office, hospice care facility, ambulance service, pharmacy, rehabilitation center, or any other type of healthcare provider overbills Medicare.

 

Who can report Medicare fraud?

Medicare fraud whistleblowers are almost always healthcare professionals. They are commonly employed as hospital administrators, nurses, hospice or nursing home workers, ambulance drivers, pharmacists, or as any other type of healthcare professionals.

Receive a financial reward for your information.

Healthcare professionals may be entitled to a significant financial reward for becoming Medicare whistleblowers. Learn about receiving a financial reward for your information here.

 

Types of Medicare Fraud
Drug Good Manufacturing Practice Violations
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The False Claims Act helps the US government prosecute contractors to federal programs who commit fraudulent activity. Many cases of abuse in areas like Medicare fraud and defense contractor fraud have been tried under this Act.

 
Pharmaceutical pricing fraud
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The US government is the world’s largest purchaser of prescription
pharmaceutical drugs. Most of those purchases come in the form of reimbursements for Medicare, Medicaid and TRICARE claims made by patients in these programs.

 
OIG warns of Hospice care Medicare fraud
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The Office of Inspector General (OIG) has issued a special fraud alert, alerting the public to the high potential for fraud between hospices and nursing home operators.

 
Improper off label drug use Medicare fraud
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Few industries are so heavily monitored and tightly controlled as the pharmaceutical industry. And rightly so since prescription drugs are so widely used. No part of the health care system has grown as rapidly or is more extensively used than the prescription drug benefit. In 2009, the U.S. used 3.9 billion prescriptions at a cost of $300 billion.

 
Durable medical equipment Medicare fraud
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Medicare and/or Medicaid pays for certain durable medical equipment (DME) when it’s been ordered by your physician through the issuance of a Certificate of Medical Necessity, or CMN. What is durable medical equipment? It’s typically medical equipment that can be used repeatedly and is often used in the patient’s home or other place of residence, such as a nursing home.

 
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