Medicare, which is Federally Run Insurance/Heath Care System, is one of the most controversial departments of the US Government. It is often ripe with fraud and many in the Health Care Industry feel that Medicare and Medicaid do not pay enough to cover the costs of their service. However, many others, including many of those who are on Medicare, feel that it offers a quality of service that would be unaffordable for many seniors.

Medicare Fraud is actually one of the biggest downsides of Medicare and is something that is constantly occurring. For example, just in the last day, there are about 1000 newspapers articles in the Google News Database that are about Medicare Fraud. Of course, many of these are likely about similar cases, but it serves to illustrate how prevalent this problem is in Medicare.

Medicare Fraud Watch

In Miami, the owner of a Medicare Clinic is facing prison time and will be sentenced today, after submitting $100 million of fraudulent HIV claims and $30 Million in Fraudulent Medicare Claims. This occurred not only in Florida, but also North Carolina, Georgia, South Carolina, and Louisiana. Michel De Jesus Huarte, the owner of the clinic, faces up to 20 years in prison, while six others are also facing prison time.

In California, the owners of a Medical Center that found homeless people and preformed unneeded services on them has been ordered to pay $10 Million. The owners paid people who worked at homeless shelters to act as recruiters, finding homeless people that were on Medicare or Medicaid and paying using them, albeit as employees, in defrauding the government.

In Houston Texas, several individuals who own a durable medical equipment company were just sentenced to repay $36 Million in fines, after they used their position in the home medical equipment industry to bill Medicare for different types of durable medical equipment, like adjustable beds and mobility scooters, which was never actually given to the patient.

Common Types of Medicare Fraud

There are a lot of different types of Medicare Fraud, but more often than not, it is the suppliers of durable medical equipment who are found to be committing these crimes.

Medicare Part B Benefits include the coverage of durable medical equipment, which includes a wide variety of home medical equipment, such as wheelchairs, scooters, and adjustable beds. It also covers glasses, prostheses, and oxygen equipment. In most cases, providing the patient is covered by Medicare and has a prescription for the equipment, Medicare will cover 80% of the cost. There are exceptions to this rule though, such as Medicare Lift Chairs, which are not completely covered. However, for the most part, as long as there is a medical need for the item, Medicare will provide 80% reimbursement for it.

Unfortunately, the home medical equipment industry has always been ripe with fraud, not just with Medicare. This is in part because medical equipment suppliers are not necessarily run by health care professionals or doctors. Instead, they are usually business people who are out to make a profit, which of course leads to abuse. Also, it is much easier to fraudulently sell Medical Equipment than it is to bill for services that are not preformed, so Durable Medical Equipment fraud remains one of the most common types of Medicare Fraud.

Of course, as the examples above illustrate, there are many other types of Medicare Fraud and fraudulent billing is also very common.

The prevalence of this type of dishonest medical billing is one factor that many are using to argue against a state run health care program. However, to be fair, Insurance Fraud occurs all the time in all private insurance as well. However, since most private insurance companies are in the business of denying claims, rather than approving them, Medicare makes an easier target.