Medicare abuse happens when unnecessary costs are billed to the Medicare program.
When Medicare abuse happens, tax-payer dollars are spent on medically unnecessary care.
The extra spending decreases how much money remains in theMedicare Trust Fund.
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Medicare could charge you more in premiums and other out-of-pocket expenses to make up the difference.
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What Is Medicare Abuse?
Another portion, however, is outright due to Medicare abuse.
To protect yourself against Medicare abuse, you should probably understand what it is and what to look for.
What Is the Difference Between Medicare Abuse and Medicare Fraud?
Likewise, they could charge you for services that were not performed or for medical supplies you never received.
Inappropriate billing:You could be charged for preventive care services that are supposed to be free.
You could be asked to pay a copay when one was not needed.
Instead, your healthcare provider could refuse to bill Medicare and charge you directly for Medicare-covered services.
Others may make a run at convince you to give them that information in a phone scam.
Be careful because they could then use your Medicare number to submit false claims.
A healthcare provider or facility could unbundle those services and charge you for each one separately.
They can also overuse services by recommending excessive office visits and laboratory tests.
Likewise, they could prescribe more medication than necessary to treat your condition.
Charging more than recommended for services and supplies: Medicare sets rates for its services each year.
Aparticipating providercan charge no more than that amount.
Anyone committing Medicare fraud and abuse can face serious consequences ranging from imprisonment to financial penalties.
Medical licenses could also be suspended or revoked.
It often happens on a much smaller scale.
Through no fault of your own, it could even happen to you.
you’re free to be proactive by keeping your eye out for any suspicious activities.
CMS will mail this to you every four months.
It includes a list of all the Medicare services you received during that time.
double-check the MSN matches your records.
They will include similar information.
The first thing you will want to do is reach out to your healthcare providers office.
It could be a simple billing issue that can be easily corrected.
Summary
People who abuse Medicare increase how much Medicare spends, but they do so unintentionally.
Whether its fraud or abuse, unnecessary costs to the Medicare program cost everyone.
Knowing what to look for will protect you and the Medicare program at large.
Be proactive and report any suspicious activity when you see it.
A Word From Verywell
Medicare abuse is an all too common practice.
When you find a discrepancy, dont hesitate to look into it.
One of the most common types of Medicare abuse is improper medical billing.
Healthcare providers, medical facilities, and medical supply companies may overcharge for services.
Medicare and Medicaid are both funded by the federal government.
It is illegal to target either program for personal gain.
Medicaid abuse happens when an individual, group, or institution inadvertently adds costs to the program.
As with Medicare, the most common abuses are overutilization and overbilling of services.
Centers for Medicare & Medicaid Services.Medicare fraud & abuse: prevent, detect, report.
Medicare.gov.Does your provider accept Medicare as full payment?
AARP.Does Medicare cover medical equipment and supplies?
Department of Health and Human Services Office of the Inspector General.Medicare fraud strike force.
Department of Justice.DOJ announces coordinated law enforcement action to combat health care fraud related to COVID-19.
Department of Justice.National health care fraud enforcement action results in charges involving over $1.4 billion in alleged losses.
“Medicare summary notice” (MSN).
