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Common Examples Of Medicare Fraud In Healthcare Business


Not everyone can afford to pay for their own hospitalization and medical bills. Most people live from paycheck to paycheck, making it very challenging for them to take care of their health. Fortunately, Medicare is available for US citizens. This program covers fees for different healthcare services such as inpatient and outpatient care, as well as doctors’ services.

Medicare aims to provide accessible and affordable healthcare services to millions of Americans, but a lot of businesses have utilized this program for their own good. Today, more and more healthcare businesses have committed Medicare fraud as an attempt to make money and take advantage of other people by depriving them of their rights.

Listed below are some of the most common examples of Medicare fraud in the healthcare business. This information will enable you and your loved ones to use Medicare coverage and avoid any inconvenience when using this insurance.

  1. Billing For Medically Unnecessary Services Or Supplies

AdobeStock_172335793.jpegA person has to undergo several tests in order to determine if they are suffering from a specific medical condition. If you suspect that you have gynecological problems, for example, you have to consult with a gynecologist and undergo several tests such as wet mount, whiff test, vaginal pH, and oligonucleotide probe.

Billing for unnecessary medical services or supplies is one of the most common Medicare fraud committed by professionals in the healthcare industry. Countless physicians have faced allegations of billing Medicare for medical services or supplies that are not medically necessary for the condition of the patient.

As stated in the website of Price Armstrong LLC, this medical fraud is very common even among large hospice providers such as AseraCare.

  1. Billing For Services Or Supplies That Were Not Provided

Patients would use their Medicare and even pay for additional fees because they want to make use of a professional’s service. Taking care of one’s health is an important yet very challenging task, which is why people around the world would opt to seek professional help. Physicians and other healthcare institutions would abuse this need and bill Medicare for services that they did not provide to their patients.

Phantom Billing” is a practice that is becoming more prevalent today. Under this scheme, physicians will seek reimbursement from Medicare for services that were not actually given or provided to their patients.

  1. Falsifying Patient Records                  

Passing the medical board exams is not an easy feat because one has to spend a lot of time and money to earn a medical degree, as well as review for the exam. For physicians to make use of their skills and education, they charge patients for their services. Although this is today’s status quo, a lot of physicians would go overboard and falsify their patients’ records just so they can seek a bigger reimbursement claim from Medicare.

Falsifying patients’ medical records—which can include inconsistencies in the patients’ medical bills and interruptions in the chronology of dates—is another common Medicare fraud in the healthcare business. Physicians would manipulate their patients’ medical records to get more money from their Medicare claims.

  1. Unbundling Of Services

Under Medicare, certain services are reduced and billed together. For example, patients who are about to undergo cardiac and orthopedic surgeries no longer need the professional fee of their physicians on a separate bill as this is charged along with their surgery covered by Medicare. This will allow patients to save money and reduce stress when preparing for their major operations.

However, not all physicians offer these bundled services to their patients because some will actually “unbundle” them and bill Medicare for different services. Unbundling services as an attempt to claim bigger reimbursement rates is a common Medicare fraud practiced by several physicians in the healthcare business.

Stay Vigilant

From all these examples enumerated above, it’s easy to see that the primary purpose of Medicare fraud is to get unfair, high payouts from healthcare programs funded by the government. While it’s meant to be a functional program, it has unfortunately fallen prey to abuses.



  1. Knee brace offer over the phone is charged to Medicare #.
    They wanted my information, which they ar
    That they seemed to have…
    I thought it was Medicare issuing me a new card.
    Confusing call
    I reported it to Medicare, and the said to return the package…