With telemedicine becoming more popular, medicare fraud targeting this new area has been on the rise.

The caller said he was with Medicare. John Ernest didn’t believe him, said “no” to the brace and hung up. He didn’t give out his father’s Medicare number.

And yet, not just one, but 13 braces arrived soon afterward at Ernest’s house in central Pennsylvania.

Further Reading:

Medicare fraud is not new. According to NPR,

“It’s clearly a profitable business. Taxpayers are the ones who ultimately pay for Medicare fraud, which often leads to higher health care premiums and higher out-of-pocket costs.”

Types of Medicare (and general insurance fraud) include:

  1. Phantom billing: The medical provider bills Medicare for unnecessary procedures, or procedures that are never performed; for unnecessary medical tests or tests never performed; for unnecessary equipment; or equipment that is billed as new but is, in fact, used.
  2. Patient billing: A patient who is in on the scam provides his or her Medicare number in exchange for kickbacks. The provider bills Medicare for any reason and the patient is told to admit that he or she indeed received the medical treatment.
  3. Upcoding scheme and unbundling: Inflating bills by using a billing code that indicates the patient needs expensive procedures. (Wikipedia)

Occupational Therapy Role In (Medicare) Fraud Prevention

  • As a practitioner, document in a timely manner and accurately.
  • Educate clients and family members to:
    • Not provide personal information to unsolicited phone calls.
    • Protect health insurance ID like a credit card.
    • Be careful of phishing e-mails claiming to be from Healthcare.
    • Read policy and benefits statements.
    • Beware of “free” offers. Offers of free health care services are designed to bill the client and their insurance company illegally for treatments or equipment they never received.
OTDUDE
About the Author: Jeff is the lead author and editor of OTDUDE.com, where he covers all things Occupational Therapy.