What Is Medicare Fraud?

To understand Medicare Fraud, you first need to know what Medicare is and who it serves. Medicare is a government-funded health insurance program for American age 65 and older who have worked and paid into the system. Medicare also funds health care for people younger than 65 if they have disabilities. Medicare may also fund treatment for people with end stage renal disease and amyotrophic lateral sclerosis.

Medicare fraud occurs when companies, organizations or individuals attempt to get the government to pay for goods or services by claiming those expenses are essential for Medicare patients when, in fact, they are not legitimate charges. For example, a hospice provider was recently found guilty of bilking taxpayers out of almost $70 million by falsely billing Medicare. The hospice company submitted false hospice claims for patients who were not terminally ill, and admitted and kept ineligible patients under the care of its staff.

There are a variety of schemes criminals use to commit Medicare Fraud. These may include false billing for services that were never performed or were not needed by patients, and paying illegal kickbacks to physicians for patient referrals.

Medicare fraud may occur in industries including home health care, psychotherapy, medical equipment, physical and occupational therapy and in the pharmaceutical industry. In fact, the fastest growing sector of the Medicare program is its prescription drug benefit program, Part D, making it a wide target for fraud.