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
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.

Long term care hospital Medicare fraud
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Medicare fraud takes many forms and its astute practitioners know all the angles when it comes to illegally going after the government and the people’s taxpayer dollars. One particular prevalent Medicare fraud practice involves long term acute care hospitals (LTACH) and Medicare patients needing their services.

Deputy Inspector General discusses nursing home Medicare Fraud in the US
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The House Government Reform and Oversight Human Resources and Intergovernmental Relations Subcommittee on Human Resources hosted George F. Grob during hearings on nursing home Medicare fraud.

Ambulance fraud
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The Medicare program represents the biggest pot of gold or perpetual payday for those who seek ways to tap its almost endless coffers. And while fraud has many faces, one area where attempts have been made to grab the gold is the ambulance transport industry. Most providers are honest and ethical but exceptions exist, as we shall see below.

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