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Health care fraud costs! In the U.S., we lose as
much as $80 - $100 billion each year to health care fraud and errors.
Medicare lost more than $16 billion dollars to fraud, abuse and errors
in 2004. Consumers lose as much as $10 billion per year.
Health care fraud is not just about the government or someone else
losing money. People get sick, lose benefits, lose money, and get stuck
with bad equipment or other things they don’t need. Although the vast
majority of providers are honest, the remaining few result in wasted
funds for the Medicare and Medicaid programs and a loss of quality of
care for yourself and others.
Who might commit health care fraud? Fraud and abuse can occur in
these areas: Home Health Services, Durable Medical Equipment (DME),
Medical Equipment Suppliers, Pharmacies, Nursing Homes, Physician’s
Practice, Hospitals, Laboratories, Hospice Services, and Transportation
Providers.
Examples of Fraud and Abuse:
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FRAUD
IS:
An
intentional deception or misrepresentation which could result in an unauthorized benefit.
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ABUSE
IS:
Incidents or
practices inconsistent with sound medical or business practices.
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It
may be fraud if it sounds like:
- Billing for services or supplies not provided.
- Altering claims to obtain a higher payment.
- Applying for duplicate payment.
- Using another person’s Medicare card
- Soliciting, offering or receiving kickbacks, bribes, rebates or other payment for
patient referrals.
- Unnecessary lab services.
- Billing for equipment not delivered.
- Billing for non covered services as covered.
- Unnecessary ambulance service.
- Continuing to bill for items (DME) no longer used.
- Billing for home health aide who does not show up for work.
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It
may be abuse if it sounds like:
- Charging excessive amounts for services or supplies.
- Claims for unnecessary services or supplies.
- Breaching the assignment agreement.
- Improper billing: i.e., billing at a higher rate than for non Medicare patients.
- Billing Medicare instead of primary insurers.
- Issuing denial notices to beneficiaries regardless of services required.
- Providers failing to bill or refusing to bill Medicare for services covered
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 To
report suspected fraud,
waste and abuse, call:
toll free:
1-800-938-8885
or
(804) 644-5628
(in Richmond)
Every report counts!
You can make a difference! |
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Place Like Home | Related Sites
Virginia Association of Area Agencies on Aging
24 E. Cary Street, Suite 100
Richmond, Virginia 23219
Phone: (804) 644-2804
Fax: (804) 644-5640
Email: info@thev4a.org
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