Utah Whistleblower Hotline

10 most common kinds of Medicare or Medicaid healthcare fraud

In any industry, there are unscrupulous people who try to defraud companies and individuals – and healthcare fraud is no exception. Medicare and Medicaid fraud is particularly troublesome because this type of healthcare fraud can cost Federal health care programs billions of dollars, while risking the health and welfare of patients at risk.

A single person can make a difference. If you work in the healthcare industry, you play a vital role in protecting the integrity of Medicare and Medicaid. Most healthcare fraud and abuse are uncovered and revealed by people who work within the industry, and who observe or suspect abusive practices and civil or criminal activity. When ordinary people become whistleblowers, they help combat fraud and abuse and may even save lives.

How you can help stop healthcare fraud

The ways in which crooks attempt healthcare fraud and try to cheat Medicare or Medicaid are numerous and varied. Here are 10 of the most common ways hospitals, clinics, or healthcare providers may attempt to game the system for profit:

  1. Charging for services, supplies, or tests that the patient didn’t receive
  2. Padding the hourly charge for procedures or patient visits (i.e. routinely adding 30 minutes to a patient visit)
  3. Charging for services or tests the patient doesn’t need (e.g. frequently ordering unnecessary blood work)
  4. Lying about any work or service performed
  5. Inflating the diagnosis in order to upcode the billing statement
  6. Unbundling services billed to Medicaid or Medicare (i.e. billing for individual tasks that really consist of one larger procedure)
  7. Receiving or paying kickbacks for client referrals or to use particular products
  8. Burying unallowable or unreasonable costs in hospital cost reports
  9. Billing Medicaid or Medicare for samples of drugs the hospital or doctor received for free
  10. Using unskilled or unlicensed workers for procedures or services which should be performed only by trained, licensed, or skilled personnel.

If you know of a healthcare company or healthcare provider cheating Medicare or Medicaid in any of these or other ways, you may be eligible for a whistleblower reward. To get a confidential evaluation of your case from an experienced whistleblower attorney, contact our whistleblower hotline by email or by calling (801) 323-500.

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