What Does Medicare Call Fraud? Home Care Path

Medicare defines fraud as a health organization knowingly presenting a false claim for reimbursement. Large health care organizations will consistently alter their delivery system to meet federal requirements for maintaining the in- flow of reimursement money. Medicare has identified many opportunities in which health organizations fix billing resulting in fraud.
1. Billing for services that were never done
2. Billing for procedures that were completed just to result in higher level of reimbursement
3. Billing for equipment and supplies never ordered
4. Billing for new equipment but giving the patient used
5. Billing for expensive equipment while purchasing the cheaper for actual patient use
6. Someone other than the MD is completing the certificate of medical necessity
7. Bill for tests performed as the result of values beyond a range (no MD ordered)
8. Bill for diagnostic tests never actually performed
9. Bill with fake codes to increase reimbursement
10. Free community testing to retain MC/MA numbers
11. Billing with seperated procedural codes to increase reimbursement (unbundle)
12. Billing more than once for the same procedure
13. Bill for brand name drugs and give generic
14. Bill for employees service when employee never present
15. Inflating cost reports to increase reimbursment
16. Billing for nursing home level of care when patient housed in assisted living facility
17. Not charging assigned copayments to increase population being served