General list of types of fraud against Medicare/Medicaid

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.