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How to recognize common forms of Medicare fraud

On Behalf of | Dec 17, 2018 | Firm News |

Working in a hospital can be both a rewarding experience and a draining one. The flurry of activity and continual challenges that the job provides can be thrilling to some.

However, in such a fast-paced environment, mistakes are bound to happen. Especially when it comes to paperwork. So how can you tell when a billing error is just a mistake or if it could point to a bigger issue?

Spotting common fraud techniques

Unfortunately, Medicare fraud is a huge problem in the healthcare industry. It costs the government billions of dollars a year and stops people from getting the treatment they need.

There are ways you can spot potential fraud, by looking for a pattern of these behaviors:


When a doctor or hospital bills Medicare for a procedure that costs more than the one performed. Upcoding is particularly damaging to patients. Not only does it take money from Medicare but it raises a patients’ diagnosis. This can lead to overtreatment.


A doctor will charge Medicare for each step in a procedure separately. This way, they can tack on extra fees and costs associated with each step of the same procedure. Imagine if a surgeon charged someone not only for a completed surgery but for their time spent scrubbing up and commuting to the hospital as well.


This is another form of upcoding, where a health professional will perform unnecessary treatments in order to bill them. This is damaging both financially and to someone’s physical well-being. Unnecessary procedures bring extra risk. They can erode the confidence in a hospital or open it up for malpractice lawsuits.

How and why to act

If you observe fraud taking place in your hospital, you can do something about it. An attorney skilled with qui tam cases can help you figure out your next steps.

Exposing Medicare fraud can help your hospital and bring personal benefits. Whistleblowers are entitled to a portion of the penalties that come with these unethical behaviors.