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What is Medicare Fraud?

Written by Ankin Law Office

The stories coming out of the Medicare fraud scandal at Chicago’s Sacred Heart Hospital are astonishing. According to the Chicago Tribune, one doctor allegedly overdosed patients with sedatives in order to necessitate tracheotomies and lengthy hospital stays and then billed Medicare for the treatment, which cost taxpayers about $160,000

Unfortunately, this is just the tip of the iceberg when it comes to Medicare fraud. The healthcare industry currently accounts for about $2.8 trillion – a fifth of the U.S. economy. In fact, as this Chicago Tribune article points out, Americans spend more than twice as much on health care each year than they spend on food, yet America scores just average, or below average, on most health indicators among developed nations.

Of the $2.8 trillion that is spent on health care, approximately $800 billion is paid by taxpayers via the Medicaid and Medicare programs, of which $60 billion is attributed to Medicare/Medicaid fraud.

Medicare fraud generally refers to any conduct by an individual or entity that results in the collection of Medicare or Medicaid reimbursements under false or illegal pretenses. Common types of Medicare fraud include:

  • Phantom billing, which occurs when a medical provider bills Medicare for unnecessary medical procedures, tests, or treatment, or procedures, tests, or treatment that was never performed.
  • Patient billing, which occurs when a patient who is involved with the scam provides his or her Medicare number in exchange for kickbacks so that the health care provider can bill Medicare for various services.
  • Upcoding schemes, which occurs when a health care provider inflates bills by using a billing code that corresponds with an expensive medical procedure.

Not only does Medicare fraud hurt the public by causing taxpayers to spend billions of dollars on unnecessary or unperformed medical care, but it can also hurt patients by resulting in the delivery of substandard medical treatment. In fact, Medicare fraud can put the lives of patients at risk, as is the case at Chicago’s Sacred Heart Hospital where several patients subject to unnecessary and potentially dangerous medical treatments as part of a Medicare scam.

To date, seven individuals – including Sacred Heart’s owner, a high-level executive, and five doctors – have been charged in connection with an alleged kickback and Medicare fraud scheme that allegedly consisted of illegal kickbacks for Medicare/Medicaid patient referrals and unnecessary medical treatments, including unnecessary tracheotomies.

How to Protect against Medicare Fraud and Unnecessary Medical Procedures

It is important that patients remain vigilant and proactive about their health care. Patients obtain a second opinion before undergoing any invasive procedure whenever possible. Moreover, if you suspect that a doctor or health care provider is engaged in Medicare fraud, it is important to report it to the appropriate authorities and consult with a skilled whistleblower attorney like those at Ankin Law Office, LLC.

Contact our office at (312) 600-0000 to schedule a free consultation with one of our skilled Chicago Medicare fraud attorneys.

Categories: Medical Malpractice