• Charging for services or supplies not provided.
• Upcoding: using a more expensive Current Procedural Terminology (CPT) code when billing for services, including office visits and medical procedures. The code sets the amount that will be paid.
• Billing for unnecessary services or tests given to patients.
• Unbundling: certain groups of related services or supplies are to be bundled under a single code; unbundling them results in higher reimbursements.
• Billing again for services already provided and paid.
• Falsifying cost reports to get increased compensation.
• Prescribing medications or devices for off-label or unapproved uses to increase profits. The Food and Drug Administration regulates medications and decides what they can be used to treat. Off-label means a drug is used for some other illness. This may be acceptable medical practice, but the fraud will occur if the drug is used for something for which it has no medical value, but is prescribed simply because it brings a higher fee.
• Submitting claims for services provided by unlicensed providers.
• Giving kickbacks to doctors or patients.
• Falsifying doctors’ orders showing a medical necessity for services and supplies.
• Billing for services provided to deceased beneficiaries or provided by deceased providers.
• Billing noncovered or nonchargeable services as covered items.
• Cherry-picking beneficiaries who need fewer health services.
• Failing to provide medically necessary services.
• Inappropriately overestimating or underestimating bid amounts of payment.
Related FAQs
What Are Migrating Medicare Schemes?
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Is There a “Top 10 Most Wanted” in Medicare Fraud?
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What Are Viral Medicare Schemes?
