Medicare fraud is designed to defraud the government agency that provides benefits to elderly health care patients. The results increase the tax rates, increase the costs of health care insurance and negatively affect society, so there are laws against it. Medicare fraud and Medicare abuse sound similar but are applied differently in different cases of fraud in South Carolina.
Medicare fraud is the use of false information to obtain Medicare health care benefits that are not entitled to the applicant. The primary purpose of fraud is to use deception to obtain money illegally. The types of fraud include phantom billing, patient billing, identity theft, upcoding and unbundling. Most fraud is committed by health care workers who record the information on medical bills that are sent to the insurance companies.
Medicare abuse consists of excessive practices that result in expensive, unnecessary costs to the Medicare program. An example is a hospital billing Medicare for procedures that were never performed or forcing a Medicare patient to undergo unnecessary procedures. Patients are committing abuse if they knowingly give their insurance numbers to providers who charge the insurance company for unnecessary services that they don’t need. These actions are abusive if they are unnecessary and do not contribute to the patient’s well-being.
Protecting the integrity of health care agencies
Medicare is designed to help disabled and elderly people pay for continuous, long-term health care services and products. Medicare fraud and abuse are committed by benefits recipients, medical providers, business owners and insurance companies. The government has its own federal and state agencies that are designed to combat fraud and abuse at all levels of the government.