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What are the differences between Medicare fraud and abuse?

Many older residents in Florida are on Medicare. Unfortunately, Medicare fraud and abuse sometimes occur. It’s important to know the differences between them.

What is Medicare fraud?

Medicare fraud is a type of fraudulent activity committed by an individual or facility when it deliberately and knowingly deceives Medicare. The purpose behind this fraud is to receive undeserved payments or kickbacks.

Some examples of Medicare fraud include:

  • Submitting claims for services that were not used
  • Making false claims or adding false information to medical records
  • Changing dates and information of services rendered
  • Billing much higher for services than those provided
  • Falsifying a patient’s eligibility
  • Not disclosing other insurance coverage

What is Medicare abuse?

Medicare abuse takes place when a provider tries to obtain undeserved payments from Medicare. However, unlike Medicare fraud, Medicare abuse is often unintentional.

Examples of Medicare abuse include:

  • Failing to maintain proper medical records
  • Improper billing
  • Not providing or allowing access to medical records
  • Submitting claims for services that aren’t necessary
  • Waiving deductibles

What are the impacts of Medicare fraud and Medicare abuse?

Although Medicare fraud and Medicare abuse differ due to the factor of intent, both are problems that can cost billions of dollars every year. While inappropriate, sometimes, illegal claims are made to the Medicare system, and it results in everyday people losing their tax dollars. People who are on Medicare can end up suffering by being denied certain medical services they need as a result.

Most doctors and other medical professionals strive to provide the best quality care to their patients. Often, when there’s a problem involving Medicare, it could simply be an honest mistake rather than healthcare fraud. There is a longstanding relationship involving trust between healthcare professionals and Medicare. Patients rely on Medicare for all their medical needs.

Medicare fraud and abuse are serious. If you’ve been accused, protect your rights.