Types of Medicare Fraud and Medicaid Fraud
Long Term Acute Care Hospital (LTACH) Fraud
The ways healthcare providers cheat Medicare/Medicaid are endless. Below are just a sampling of the ways hospitals and others healthcare providers commit Medicare/Medicaid fraud:
- Charging for tests, services or supplies not actually provided
- Falsely stating how many hours were spent (i.e. routinely adding 30 minutes)
- Charging for tests or services not really needed (i.e. routine ordering of blood work, frequently
- Requesting a full panel of tests where only one or two are needed, or providing psychotherapy to people with Alzheimer disease
- Lying about any work or service performed
- Upcoding (i.e. patient really has “bronchitis”, but Medicare is knowingly billed for treating “pneumonia”)
- Billing for unallowable or unreasonable costs of goods or services
- Billing for routine supplies (i.e. band aids, lubricants, irrigation solutions, gloves, slippers, prep kits, towels, monitors, humidifiers, oxygen [by the hour], anesthesia circuits, elbow or heel pads, mask, electrodes for ECG, and foam head rests)
- Charging incremental nursing services (i.e. IV starts, and stat or monitor charges)
- Unbundling services billed to Medicare (i.e. billing for individual tasks that really consist of one larger procedure)
- Receiving or paying kickbacks for client referrals or to use particular products
- Cost report fraud (i.e. including unallowable or unreasonable costs in hospital cost reports)
- Billing for samples of drugs the hospital or doctor received for free
- Claiming ambulance costs for routine or non-emergency transportation
- Using unskilled or unlicensed workers
- Charging for investigational tests
- Disguising advertising or marketing costs as other costs
If you know of a healthcare company cheating Medicare or Medicaid in one of these or other ways, fill out our fraud questionnaire.