This is a great example on why we should keep an eye on our Medicare explanation of benefits forms that are mailed out to us. Unfortunately, this is a common problem.
Here an excerpt of the article by Maria Polletta of the Tucson Citizen on October 6, 2011 – You can see the rest of the article from Arizona Republic News here.
Fraudulent practices include filing claims using fake or stolen identification numbers; billing for non-covered services, such as cosmetic procedures, and calling them something else; providing unnecessary services or products just to generate payments; and billing for services that were never provided.
There’s also upcoding, or billing for a higher-priced treatment than what was actually provided, and unbundling, which involves billing a group of tests done at the same time as separate procedures to get higher payments.
Such scams or mistakes often go unnoticed, according to Spencer, because many people don’t meticulously review their Medicare statements as they might bank or credit-card charges.
“Even though you’re not paying for (Medicare) services out of pocket, you need to look carefully at those itemizations,” he repeatedly told the group.