Medicare/Medicaid Billing Fraud: SERVICES NOT RENDERED/ADD-ON SERVICES

One of the most straightforward examples of Medicare and Medicaid fraud committed by a healthcare provider involves billing for services that were never rendered.  Because this type of fraud is so easy to commit, it can be accomplished in many ways.  For example, in addition to billing Medicare or Medicaid for services and treatments that were never provided, this fraud can include billing Medicare and Medicaid for medical supplies, equipment, and pharmaceuticals that were never delivered, and diagnostic procedures and tests that were never performed.  These cases often involve some falsification of records to support the improper billings.

Because billing for services not rendered is so easy to do, it is one of the most common forms of fraud and healthcare providers of every sort have been cited by the government for committing this type of fraud.  For example, physicians have been held liable for billing Medicare or Medicaid for diagnostic procedures they never performed.  Physical therapists have been held liable for billing for sessions that never took place. Nursing homes have been held liable for billing for supplies that were never purchased or used.

Another straightforward example of Medicare and Medicaid fraud involves billing for unnecessary add-on tests and services.  This type of fraud often occurs when a clinical laboratory induces a physician to order unnecessary, extra (or add-on) tests or includes the tests without providing the physician the option not to order them.  In either case, the laboratory bills Medicare or Medicaid for the test without the physician’s knowledge.

If you know or suspect that a healthcare provider is billing Medicare or Medicaid (or other government program) for services that were not provided or for add-on services, please contact Michael S. Bigin or Laurence J. Hasson.