SENIOR LISTENING Lisa Baxter, Aging Service Specialist How Does Medicare Fraud & Abuse Affect Me?
June is Medicare Fraud Prevention Month.
First, what is the difference between Medicare Fraud and Medicare Abuse.
Abuse is when Medicare is overcharged or unnecessary services are billed to Medicare. The net effect extra tax-payer funds are spent which depletes the Medicare Trust Fund. Medicare abuse is not always intentional but its effect on the Medicare program is the same.
Examples of Medicare abuse are upcoding of a Medicare claim to a more complicated service or for longer time frames or adding billing modifiers for a higher level of service.
Other examples include unbundling of services to avoid Medicare's flat rate or ordering unnecessary tests, supplies or medications.
Medicare Abuse constitutes fraud when the entity or provider knowingly goes ...